Nerve wrapping

Nerve scarring can cause severe pain and dysfunction. Treatment of the scarred nerve frequently yields unpredictable results. A barrier wrap around the scarred nerve could be of benefit in preventing the recurrence of epineural scarring following neurolysis. The barrier would ideally be inert so as to not incite an inflammatory response, and be nondegradable. Veins fulfill both of these objectives. The desirable qualities of a barrier nerve wrap include a substance that decreases nerve scarring, does not constrict and thus compress the nerve, and improves nerve gliding. The primary indication for nerve wrapping is a nerve with adherent scar.     

Nerve grafting

For a long period, nerve grafting was used as a last resort when other means to manage a nerve defect failed. All attempts to apply allografts were disappointing. With the development of a new technique based on microsurgery, free nerve grafting has become a reliable method. The results are close to the results achieved by neurorrhaphy under favorable conditions and better than the results achieved by neurorrhaphy under tension. Today, this fact is recognized by nearly all surgeons. Discussion is limited only to the length of defect that still permits application of neurorrhaphy or represents an indication for nerve grafting. It is logical that different surgeons have different results, according to their training, their background, and the cases they have to treat. If the material contains more fresh cases, neurorrhaphy will be favored; if it contains more late secondary cases, nerve grafts will be applied in a higher frequency. The vascularized nerve graft is a new technique that certainly will have its indication in selected cases. If the immunologic problems connected with nerve grafting will be solved in one or the other way, a new era of nerve grafting will commence.