Repair of Peripheral Nerves by Grafts of Frozen-Dried Nerve. ∗

Abstract

Orientation, growth rate and grouping of growing nerve fibers are determined by the biophysical and biochemical constitution of the interfaces along which they advance. 1 Their most favorable growth medium is degenerated peripheral nerve. 2 Accordingly, peripheral nerve fragments are the best means of bridging traumatic nerve gaps. 3 In mammals, autografts can be fully, homografts adequately successful; 4 heterografts are largely discredited. 4 , 5 Nerve grafting in man has met with the difficulties of (1) growth-obstructing fibrosis of the distal suture line, and (2) unavailability of grafts. The former may be obviated by resection of the barrier, 6 or possibly completely avoided if sutureless nerve splicing by arterial sleeves 7 should prove as successful in man as it has been in animals. The supply difficulty is more serious, since commonly no source other than the patient's own intact nerves is available. In order to avoid having to sacrifice a “minor” nerve for the repair of a more vital one, several authors have tried preserved or fixed nerves. Storage in petrolatum 8 leaves the grafts viable, but presumably not indefinitely. Alcohol-fixed grafts 8 , 9 lead to poor regeneration, 5 formalin-fixed grafts to complete failure. 9