2026 Volume 37 Issue 1 Pages 37-44
Despite significant progress in basic research on peripheral nerve regeneration, improvements in clinical functional outcomes after peripheral nerve reconstruction remain limited. In the United States, however, several novel surgical concepts and technologies have been developed and disseminated through the American Society for Peripheral Nerve (ASPN) , although they are not yet widely adopted in Japan. This review summarizes clinically relevant topics in peripheral nerve surgery that have gained attention in the field of plastic and reconstructive surgery and discusses future perspectives for their implementation in Japan.
Processed nerve allografts (PNAs) , created by decellularizing human donor nerves while preserving native extracellular matrix and microarchitecture, have emerged as a promising alternative to autologous nerve grafts and synthetic conduits. Multicenter prospective studies and large registry analyses have demonstrated reliable sensory and motor recovery, even in medium- to long-gap nerve defects exceeding 25–50 mm, where conventional conduits often show limited efficacy.
Brief electrical stimulation (BES) applied to the proximal nerve stump at the time of repair has also been shown to accelerate early axonal regeneration by enhancing axonal sprouting and reducing regeneration delay, and it is considered readily applicable in clinical practice.
In addition, nerve decompression surgery for painful diabetic peripheral neuropathy has been reported to alleviate pain, improve sensory function, and reduce ulcer recurrence and amputation risk by addressing superimposed entrapment neuropathy. Recent randomized controlled trials and meta-analyses have strengthened the evidence supporting its long-term effectiveness.
Migraine headache surgery, based on the concept of peripheral nerve compression at specific trigger sites, has likewise demonstrated significant improvements in headache frequency, intensity, and duration, although further interdisciplinary validation is required.
These emerging approaches suggest a paradigm shift in peripheral nerve reconstruction by integrating biological, physiological, and functional strategies beyond conventional microsurgical repair. Addressing regulatory, institutional, and interdisciplinary challenges will be essential to translate these advances into clinical practice in Japan.
