Experimental and clinical evidence indicates that in a badly scarred bed a vascularized nerve graft will surpass a nonvascularized nerve graft. Long nerve gaps and proximal lesions have been advocated as an indication for the use of vascularized nerve grafts. The theory is that rapid axonal regeneration produces earlier end organ reinnervation and thus superior results. Brachial plexus lesions were used as a clinical model to investigate this hypothesis. A rapidly advancing Tinel's sign did indicate rapid axonal elongation, but the follow-up in some of these clinical reports was not accurately documented or is as yet incomplete, and thus we are still lacking concrete evidence of the superiority of the final functional result with vascularized nerve grafts. We now have a wide choice of available donor vascularized nerve grafts and the technical expertise to use them. However, the exact indications for their use remain controversial. Further advances in the establishment of both better laboratory models and comparable clinical settings are necessary before these indications for vascularized nerve grafting will be widely accepted.
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