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Peripheral nerve defects represent a frequent lesion in emergency. The vein graft is the alternative to nerve graft in cases where the nerve defect does not allow a direct approximation. Our experience on the use of venous graft has brought about excellent functional results that, together with a simple execution of the methodology, are at the bottom of our study. During the last 6 months we have treated 3 cases of peripheral nerve defect with nerve gap >2 cm; 1 lesion of ulnar nerve, 1 lesion of median nerve treated with vein graft and in 1 case an association of the median and ulnar nerve treated with reversed vein graft. An immediate resolution of the pain was observed in all patients already during the first 36/48 hrs. The clinical and electrophysiological evaluations at 3 and 6 months have demonstrated encouraging data regarding functional reparation and re-innervation. Even in consideration of the limited number of cases, comparison with data related to the autologous nerve graft shows a slightly slower recovery, but certainly overlapping to the classical methodology; moreover, excellent clinical results appear from the use of reversed vein graft. The advantage of vein grafts are multiple. There is an overlapping of the functional recovery, that represents the condition sine qua non of each new surgical experimental procedure. The simplicity of the technical execution and the possibility to cover missing nerves without sensory damage is advantageous both for the patient and for the structure, reducing operating time and related costs.

Apart from the basic aim of revascularization, other criteria for the success of digital replantation are functional and sensory recovery. Tactile gnosis can only be restored in cases of replantation distal to the wrist by paying great attention to the technical details for nerve repair. Of 253 patients who underwent 312 digital replantations, after total or subtotal amputations, over 16 years, 162 with 215 successful replantations and 377 nerve reconstructions returned for follow-up evaluations. Of 320 patients who underwent 395 nerve repairs after isolated severed digital nerves, 198 with 249 nerve reconstructions returned for follow-up. Our aim was to determine in both groups, the level of sensory recovery for primary nerve repair as well as for primary and secondary nerve grafting by evaluating the results according to the score of Highet. The majority of the patients in both groups reached stage S3 to S4 on the sensory recovery score of Highet. Patients with isolated severed nerve reached stage S3+ more often than the patients with nerve reconstruction after replantation. The evaluation of results takes into consideration factors influencing digital sensibility such as the level and type of injury, the length nerve grafts, cold intolerance and the patient's age.

The authors present 4 cases of vascularized nerve graft. The results were better than those obtained with traditional grafting. The indication is a rare one, and the experimental results are contradictory. Indications are limited to Volkmann ischemic syndromes, post-actinic lesions of the brachial plexus, infections and finally, post-burning scarring. Nevertheless, traditional nerve grafts remain the treatment of choice for peripheral nerve lesions which cannot undergo direct suturing.