Interfascicular nerve grafting.

We have reviewed the technique of interfascicular nerve grafting and reviewed the results of 60 nerve grafts in 33 patients. After reviewing our results and comparing them with the literature on nerve grafts and direct repairs, the results are comparable and, in some series, better with nerve grafts. These observations support Millesi's original reports of favorable results from interfascicular nerve grafting. Although Millesi's results are better than reports by others, the overall results indicate nerve grafting is a preferable option to repair under tension. The minor sensory loss from the sural nerve donor defect was not bothersome in our patients. We will continue to prefer nerve grafting to extensive mobilization or more than moderate joint flexion to overcome gaps in nerves. Although the critical gap distance remains controversial, the following advantages of nerve grafts remain: increasing comfort in use of the microscope, the ability to do better technical apposition of the nerve fascicle groups, the ability to locate the nerve away from scarred bed, and the ease of repair of the nerve with the joint in a neutral position. These advantages far outweigh the disadvantage of increased operating time and the small sensory loss from the donor nerve harvest. We believe interfascicular nerve grafting is the contemporary standard for closing significant gaps in peripheral nerves.