Peripheral nerve gap management: rock-paper-scissors.

Peripheral nerves injury is one of the topical medical, social and economic problems. One of the crucial factors of surgical treatment of nerve trunks injuries ensuring their successful regeneration is the precise and tight connection of the proximal and distal stumps. To fulfill this goal a whole wealth of suturing and adhesive materials, laser and high-frequency electric welding techniques were suggested. Currently microsurgical autoneurografting, which is considered the gold standard, is preferred in repairing nerve trunks defects. However, although effective, this surgical intervention has certain limitations, including the injury at the site of donor nerve harvesting with subsequent hypo– or anesthesia, scarring of the donor site, instances of formation of the painful neuroma of the central stump of the cutaneous nerve, lack of grafting material in the case of significant defect of the injured nerve or during reoperation, mismatch between the bundle structure of the damaged nerve trunk and the grafted segments of the cutaneous nerve. This situation stimulates the search for alternatives to autoneurografting.