Peripheral Nerve Reconstruction with Autologous Grafts

A nerve gap is defined as the distance between two ends of a divided nerve. It is caused not just by the nerve tissue lost due to the trauma, or to the following debridement, but also by the actual retraction of the nerve stumps. The retraction is due to the elastic properties of the nerve fibers. Only small nerve gaps, in which minimal tension is required to contrast the elastic properties of the nerve, can be directly repaired (Fig. 1). Any significant tension at the repair site must be managed using other techniques. Peripheral nerve injuries causing gaps larger than 1-2 cm require bridging strategies for repair. Various methods exist to reconstruct nerve lesions with a significant gap: nerve grafts as autologous non-vascularised nerves, vascularised nerve grafts, interposition of venous or arterial segments or interposition of synthetic conduits. Despite the easier availability and execution of these last options, the gold standard, in nerve repair, remains the use of nerve grafts.