Vascularised nerve grafts using composite arterialised neuro-venous systems.

The rationale for the use of revascularised nerve grafts is well established and has been proved both experimentally and clinically. It is a technique that is particularly useful if one wishes to transfer large thick grafts to repair major nerves or insert vascularised cable grafts to bridge long defects in a poorly vascularised fibrous bed of tissue. An experimental technique has been devised to raise a composite neuro-venous graft and by reversing the vein component provide an arterialised composite nerve graft that can be safely transferred to different parts of the body. Experimental work in cadavers and dogs has confirmed these observations and details of seven clinical cases are given. The results are encouraging and in patients with nerve injuries where there are associated vascular and nerve defects, as in the forearm and hand, the technique of a composite reversed neuro-venous graft which is arterialised, should be seriously considered.