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Journal of Hand Surgery (British and European Volume)
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Articles

Vascularised Nerve Grafts

M. MERLE
G. DAUTEL

Service de Chirurgie Plastique et Reconstructrice de l’Appareil Locomoteur, Centre Hospitalo-Universitaire de Nancy, Hôpital Jeanne d’Arc, Toul, and Institut Européen de Biomatériaux et de Microchirurgie, Université de Nancy I, France

Correspondence: M. Merle, Service de Chirurgie Plastique et Reconstructive de l’Appareil Locomoteur, Centre Hospitalo-Universitaire de Nancy, Hôpital Jeanne d’Arc, 54201 Toul, France.

Since Taylor (1976) successfully performed the first vascularised free nerve graft, experimental and clinical data have not provided conclusive support for the superiority of this method of repairing loss of nerve substance.

Experimental work yields conflicting results. Histologic results are in favour of vascularised grafts but non-vascularised fascicular grafts placed in a healthy bed recover sufficient neovascularisation within a short period of time (four to six days).

In the field of brachial plexus repair, vascularised grafts give consistent results. However, if thrombosis of the anastomoses occurs, the grafts fail completely.

In our experience, vascularised nerve grafts used for repairing digital nerves and arteries, have a high rate of thrombosis.

There are few potential donor sites. A nerve graft cannot be considered to be physiologically vacularised if it relies only on an artery or on an arterialised vein. Given the present state of immunosuppressant treatments, vascularised allografts are not yet appropriate.

Therefore, vascularised nerve grafts have limited applications. In general it is preferable to repair the tissue bed so as to promote revascularisation of conventional nerve grafts.

Journal of Hand Surgery (British and European Volume), Vol. 16, No. 5, 483-488 (1991)
DOI: 10.1016/0266-7681(91)90099-A
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