Nerve grafting with simultaneous microvascular reconstruction.

A new method of nerve grafting is described that introduces the one stage distant transfer of a living nerve graft by microvascular techniques. The development of this operation is outlined and the first clinical application of this technique is presented together with the preliminary reports of 2 new cases. The blood supply of peripheral nerves is examined, and consequently a neurovascular bundle is defined as the best graft for free transfer. Donor sites are suggested for both normal and unusual circumstances, and a sequence of preoperative investigations and intraoperative precautionary steps is recommended, which can also be used as a basis for microvascular free transfer of other tissues. This technique of nerve grafting is designed primarily to ensure viability of the nerve graft. Because the procedure is exacting and time consuming, it is recommended only when conventional techniques carry high risk of graft necrosis, situations in which the nerve gap is large, the recipient bed is scarred, or the free transfer of a thick nerve is desired. There are disadvantages as well as advantages of the free vascularized nerve grafts. Important new developments in the field may depend upon advances in immunology.