Surgical techniques of nerve grafting (standard/vascularized/allograft)

Tension-free re-approximation of the transected stumps of a peripheral nerve is critical to peripheral nerve reconstruction. A number of techniques, including mobilization and transposition of the damaged nerve, nerve grafts, nerve transfers, and tendon transfers, are available to facilitate reconstruction when primary neurorrhaphy alone will not adequately address the nerve gap. Nerve grafting is the most useful and commonly used technique in the microsurgeon's armamentarium for managing these segmental nerve injuries or nerve gaps. This article addresses standard nerve grafting techniques and discusses vascularized nerve grafts and peripheral nerve allografts. We also focus on the strategies that have been evaluated in animal models to minimize the requirements for immunosuppression with peripheral nerve allografts.