Tubulization techniques for the repair of peripheral nervous system injuries

Peripheral nerve surgery remotes to more than 150 years ago, and soon it was observed that termino-terminal sutures performed under tension resulted in poor functional outcomes. The use of some kind of graft tissue interposed between the traumatized nerve stumps was developed to solve these situations, but only in the 70's Millesi proved the efficacy of autologous nerves as an ideal tissue for grafting. Nowadays, the use of these grafts is the "gold-standard" treatment to severe injuries with long gaps in peripheral nerves, but the technique has some limitations. These limitations motivated the search for alternative tissues as source to sustain the grafting, beginning the development of researches about the tubulization techniques. Biological tubes, as veins or veins filled with skeletal muscles, demonstrated good results in experimental and clinical studies. In selected cases, the use of syntetic tubes - as silicon and poliglycolic acid - has also demonstrated good results. This review aims to describe the historical evolution and the results of the studies about the different tubulizations techniques used for reconstruction of the peripheral nerves injuries.