Bridging defects: autologous nerve grafts.

Autologous nerve grafting has been performed since 1876 without success. Since the 1960s, the interfascicular nerve grafting technique has provided a reliable method to bridge very long nerve defects with predictable results. Personal experience of over 40 years has demonstrated that donor site morbidity is minimal if certain precautions are observed. Donor site morbidity does not justify the use of alternative techniques. However, in vast defects like brachial plexus lesions, the number of available autografts is insufficient. We do need alternative techniques like tubulisation, however, not to replace autologous nerve grafts but to supplement them.