Free vascularized nerve transfer using microsurgical techniques for upper l
imb reconstruction should be considered as an alternative to conventional n
onvascularized cable nerve grafts when the recipient bed is heavily scarred
, as occurs in Volkmann's ischemia, when the nerve gap is exceptionally lon
g, or when the free transfer of thick nerves is contemplated. Possible dono
r sites for free arteriovenous nerve transplants or arterialized neurovenou
s systems are presented and illustrated in four patients with. follow-up in
excess of 20 years. In each case the rate of axon immigration across the v
ascularized nerve-bridge and beyond to the hand was in excess of 1.5 mm per
day.