Tiam Mana Saffari

44 CHAPTER 2 CONCLUSIONS Peripheral nerves are living dynamic tissues that thrive on nutritive blood supply. The interaction of vessels and nerves after a nerve injury is complex. Although the relationship between angiogenesis and neuroregeneration was originally thought to be related to nutritional factors, recently more evidence advocates for the Schwann cells to guide neuronal precursors via a complex pathway of factor secretion, among which VEGF, to enhance nerve regeneration. Revascularization of nerve grafts after injury relies mostly on environment and primarily on inosculation from host vessels. Clinical studies comparing VNGs to NVNGs remain lacking and existing studies are inconclusive. Future studies should be randomized and involve patients with similar injuries, nerve graft repair and follow-up times to be able to critically elucidate differences between VNGs and NVNGs. The technical obstacles could be overcome by provision of vascularized fascial flaps that enhance revascularization. The field of tissue engineering is evolving and predicted to take a larger part in treatment options for peripheral nerve injuries using biodegradable scaffolds. Acknowledgements The authors would like to thank Jim Postier (Rochester, MN) for the artwork of Figure 1 and 2. Disclosure statement No competing financial interests exist.