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Topic: Peripheral Nerve Repair and Regeneration

Vascularized nerve “grafts”: just a graft or a

worthwhile procedure?

Salvatore D’Arpa, Karel Etienne Yvonne Claes, Filip Stillaert, Britt Colebunders,
Stan Monstrey, Phillip Blondeel

Department of Plastic and Reconstructive Surgery, University Hospital Ghent, 9000 Ghent, Belgium.
Address for correspondence: Dr. Salvatore D’Arpa, Department of Plastic and Reconstructive Surgery, University Hospital Ghent,
9000 Ghent, Belgium. E-mail: salvatore.darpa@uzgent.be

ABSTRACT

The aim of this review is to extrapolate evidence regarding the use of vascularized nerve grafts (VNGs)
in peripheral nerve reconstruction and summarize available data on their indications, if any, and
clinical applications. A review of the literature via the PubMed database was performed with analysis
of ninety-five articles on the experimental and clinical studies of VNGs. Eight relevant questions were
selected to be answered about VNGs. VNGs allow faster nerve regeneration and convey a functional
advantage under certain clinical conditions such as large nerves, proximal lesions, and nonvascularized
recipient beds. Several donor sites are available which have been being divided by body region in
this manuscript. VNGs perform better than non-VNGs and provide an advantage in selected cases.
However, limited availability and donor site morbidity still limit their application. We foresee a wider
application of vascularized nerve allografts to overcome these problems.

Key words:
Nerve injury, nerve reconstruction, nonvascularized nerve graft, vascularized nerve graft

INTRODUCTION In 1976, Taylor and Ham reported the first free VNG: a
[7]
24 cm segment of the superficial radial nerve, based on
The first nerve graft was performed by Phillipeaux and the radial artery, was used to reconstruct a median nerve
[1]
[2]

Vulpian in 1870. In 1939, Bunnel and Boyes reported in a case of Volkmann’s ischemic contracture. Since then,
their experience with thin autogenous nerve grafts, several experimental and clinical studies have investigated
which were transplanted with encouraging results. Soon the role and effectiveness of VNGs although conclusive
thereafter, the clinical outcomes of free autologous nerve findings have not been reported. The fact itself that VNGs
grafting were improved by the application of cable grafts are still named “grafts” instead of “flaps” testifies the
to improve graft revascularization and avoid the central doubts surrounding the benefits of a vascularized nerve
necrosis observed in large grafts. [3‑5] repairing a nerve gap.
To overcome the problems caused by central necrosis Although it is generally believed that VNGs perform better
due to insufficient vascularization observed with for longer gaps and larger nerves or in scarred beds,
nonvascularized nerve grafts (NVNGs), VNGs were evidence is lacking. Whether a more complicated VNG
[5]
introduced as a solution to improve nerve graft outcomes. procedure is justified or not, and when, is still unclear.
The first VNG in the upper extremity was a pedicled nerve We have performed a review of the literature of both
graft, described in 1945 by St. Clair Strange. [6] experimental and clinical studies on VNGs to find answers
to the following questions:
Access this article online • What is the theoretical advantage of a VNG?
Quick Response Code: • Do VNGs have an efficient vascularization?
Website: • Is vascularization of a VNG superior to that of a NVNG?
www.parjournal.net
• Regeneration in VNGs vs. NVNG
• What are the indications for a VNG?
DOI: • Comparison of donor sites in the upper and lower limbs
10.4103/2347-9264.160882 • How should we consider the nerve incorporated in a
flap?
Plast Aesthet Res || Vol 2 || Issue 4 || Jul 15, 2015 183