Vascularized Nerve Grafts: Current Concepts, Indications, and Future Perspectives

Peripheral nerve injuries pose significant challenges due to limited regenerative capacity and functional recovery, especially in large or complex defects. Traditional repair methods using non-vascularized autologous nerve grafts often result in suboptimal outcomes due to ischemia-induced central necrosis and delayed axonal regeneration. Vascularized nerve grafts (VNGs), which provide an intrinsic blood supply, have emerged as a promising alternative to enhance nerve repair by improving graft survival, supporting Schwann cell viability, and promoting early neovascularization. This review on vascularized nerve grafting examines its advantages, challenges, and emerging experimental approaches. VNGs demonstrate superior functional outcomes compared to non-vascularized grafts, with improved motor and sensory recovery, and higher axonal density, particularly in long-gap and delayed repairs. Although the use of vascularized nerve grafts is limited by technical complexity, increased operative time, and donor site morbidity. In this study we aim to provide a comprehensive overview of the rationale, outcomes, and challenges associated with vascularized nerve grafts, while highlighting emerging experimental strategies poised to overcome current limitations in peripheral nerve repair.