A 25-year perspective of peripheral nerve surgery: Evolving neuroscientific concepts and clinical significance

In spite of an enormous amount of new experimental laboratory data based on evolving neuroscientific concepts during the last 25 years peripheral nerv e injuries still belong to the most challenging and difficult surgical reco nstructive problems. Our understanding of biological mechanisms regulating posttraumatic nerve regeneration has increased substantially with respect t o the role of neurotrophic and neurite-outgrowth promoting substances, but new molecular biological knowledge has so far gained very limited clinical applications. Techniques for clinical approximation of severed nerve ends h ave reached an optimal technical refinement and new concepts are needed to further increase the results from nerve repair. For bridging gaps in nerve continuity little has changed during the last 25 years. However, evolving p rinciples for immunosuppression may open new perspectives regarding the use of nerve allografts, and various types of tissue engineering combined by b ioartificial conduits may also be important. Posttraumatic functional reorg anizations occurring in brain cortex are key phenomena explaining much of t he inferior functional outcome following nerve repair, and increased knowle dge regarding factors involved in brain plasticity may help to further impr ove the results. Implantation of microchips in the nervous system may provi de a new interface between biology and technology and developing gene techn ology may introduce new possibilities in the manipulation of nerve degenera tion and regeneration. (J Hand Surg 2000;25A:391-414. Copyright (C) 2000 by the American Society for Surgery of the Hand.).