Free vascularized nerve transfer in the upper extremity

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.