Peripheral Nerve Grafting and Repair

H. Francis Farhadi, Wilson Z. Ray, Sean Barber, Jaime Gasco, and Justin M. Brown

How do autografts work?

Autografts serve as a bridge or structural framework to overcome irreducible nerve gaps created secondary to injury and subsequent wallerian degeneration. Nerve grafts themselves undergo degeneration when removed from their local environment, yet provide the necessary matrix for the regenerating nerve stump.1

What is the most common autograft?

The sural nerve

What are other available autografts?

• Medial and lateral cutaneous nerves of the forearm

• Dorsal cutaneous branch of the ulnar nerve Intercostal nerves

• Greater auricular nerve

• Superficial branch of the radial nerve

• Posterior and lateral cutaneous nerves of the thigh

How are donor grafts chosen?

Donor grafts are chosen based on the caliber of graft required, the total length of nerve gap, and donorsite morbidity.^2,3

Under what circumstances are nerve transfers used?

Most commonly used for brachial plexus reconstruction (especially when long regeneration distances and time from injury preclude acceptable results for grafting)^4–9

What is the benefit of nerve transfers?

Nerve transfers allow for a more distal repair (closer to the motor end plates of muscles), thus reducing the time required for regeneration.5,10 Regeneration occurs across a single repair site (cf. grafting that involves two repair sites). No need to harvest donor grafts, thus eliminating the possibility of associated morbidities.

What synthetic nerve conduits are available for nerve repair?

Currently, two collagen-based (NeuraGen™ and NeuroMatrix™) and two synthetic polyester–based (Neurotube™ and Neurolac™) conduits are available for clinical use.^11,12

What are the current indications for synthetic nerve conduit use?

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