Nerve Grafting Methods

Abstract

The logical technique for repair of nerve transections is a direct anastomosis of nerve ends and slight tension could be acceptable. However, in cases with irreducible nerve gaps, autologous nerve grafting remains the gold standard, especially following the introduction of the interfascicular nerve grafting technique. Critical gap length for nerve grafting varies according to different authors from 1.5 to 7cm but it is a more decisive factor for the quality of recovery than is the length of the nerve grafts. Despite some shortcomings of this procedure, such as anesthesia in the innervating area, scarring, and the possible formation of painful neuroma, the use of autologous grafts is an optimal procedure for most nerve repairs and only sporadically is there a need for the use of nerve conduits. This chapter is related exclusively to this technique. It is divided into several sections that include the problem of tension at the suture line, indications and timing for nerve grafting, the choice of an ideal donor, considerations on standard technique of interfascicular nerve grafting and modified technique of cable nerve grafting, and important conclusion remarks. © 2015 Elsevier Ltd. All rights reserved.