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A relevant number of peripheral nerve injuries can only be dealt through reconstructive surgical procedures. Despite continuous refinement of microsurgery techniques, peripheral nerve repair still stands as one of the most challenging tasks in neurosurgery. Particularly problematic is the fact that despite the good regenerative ability of peripheral nerves and successful surgical nerve repair functional recovery is most often disappointing in these patients (Lundborg, 2002). While direct nerve repair should be the procedure of choice whenever tension-free suturing is possible, in many cases there is a significant loss of nerve tissue and resulting nerve gap. In these cases a nerve graft might be necessary for adequate nerve repair (Lundborg, 2002). Nerve grafting, however have some disadvantages, the most prominent being donor site morbidity that may lead to a secondary sensory deficit and occasionally neuroma and pain. In addition, non-matching donor and recipient nerve diameters often occur, which might be at the basis of poor functional recovery (May, 1983). Entubulation offers advantages over autographs, including the potential to manipulate the regeneration environment within the tube-guide (Fields et al., 1989). Consequently, guidance of regenerating axons is not only achieved by a mechanical effect but also by a chemical effect (such as accumulation of neurotrophic factors) (Meek & Coert, 2002). Nerve guides can be made of biological or synthetic materials and, among the latter, both nonabsorbable (e.g. silicon) and biodegradable tubes have been used (Schmidt & Leach, 2003). Biodegradable nerve guides must be preferred since no foreign body material will be left in

Cellular Systems and Biomaterials for Nerve Regeneration in Neurotmesis Injuries