Nerve Grafts and Conduits

Abstract

Peripheral nerve defects are common. The surgeon faced with these problems must provide the best functional recovery for the patient with the tools provided. The ideal nerve reconstruction would create a tensionless repair with direct coaptation. However, this is not always possible and other techniques must be employed. The alternatives to direct coaptation include nerve autografts, nerve conduits, and tissue-engineered constructs. This article reviews commonly used autogenous nerve grafts and conduits. Autogenous nerve grafts have been utilized in various techniques which include the trunk graft, cable graft, interfascicular graft, and vascularized graft. The nerve conduits reviewed fall into the category of autogenous biological conduits, nonautogenous biological conduits, and nonbiological conduits. New technologies are being developed to enhance peripheral nerve regeneration with the concept that conduits can be enriched and manipulated in the laboratory to promote regeneration of the peripheral nerve. Further clinical studies hold the promise of successful alternatives for treating peripheral nerve injuries.

Peripheral Nerve Reconstruction after Injury: A Review of Clinical and Experimental Therapies

“…Human autografts are preferred as the literature is clear that autografting is superior to nerve conduits for longer gaps (>3 cm), more proximal injuries, and critical nerves [20]. Nerve grafts can be single, cable, trunk, interfascicular, or vascularized [38]. A single graft joins nerve gaps with a segment of a donor nerve of similar diameter.…”

Shaping the military wound: issues surrounding the reconstruction of injured servicemen at the Royal Centre for Defence Medicine

“…However, in our patient population, who have often suffered bilateral traumatic lower limb amputations, the sural nerve is not available and other donor sites for nerve graft need to be considered. These include the lateral/medial antebrachial cutaneous nerves of the forearm [55] and in highly selected cases the superficial branch of the radial nerve [56]. The graft must be reversed and interposed in a tension-free manner.…”

Surgical management of facial nerve paralysis in the pediatric population

“…Both primary neurorrhaphy and cable nerve grafting have been successfully used to repair transected facial nerves in children with excellent functional and aesthetic outcomes [44][45][46]. The ideal nerve repair uses tensionless end-to-end repair with direct coaptation and ought to be performed within 72 hours of injury [47]. If tension-free primary neurorrhaphy is unattainable, cable nerve grafting is warranted.…”