Peripheral nerve repair: innovations and future directions

Several human studies show positive signals, while research methods and sample sizes continue to develop.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Background Peripheral nerve injuries (PNIs) remain a major clinical and socioeconomic challenge, frequently resulting in motor weakness, sensory loss, and chronic neuropathic pain that cause long-term disability and restrict daily function. Functional recovery is limited by slow axonal regrowth, Wallerian degeneration, interstitial fibrosis, and progressive denervation-induced muscle atrophy. Although microsurgical epineurial repair and autologous nerve grafting are standard treatments, clinical outcomes remain inconsistent, especially in long-gap or delayed repairs. These limitations underscore the need for more effective regenerative strategies that address both the structural and biological barriers to nerve recovery. Main body Contemporary research on PNIs focuses on four interconnected domains: structural reconstruction, biological acceleration, functional remodelling, and anatomical restoration. Advanced nerve-guidance conduits offer biomimetic, aligned pathways that reduce axonal misdirection and complement microsuture or autograft repair. Biological approaches, including localized delivery of neurotrophic factors, mesenchymal stem cells, induced-pluripotent stem cell derivatives, and their exosomes, enhance Schwann cell reprogramming, angiogenesis, and pro-regenerative immune polarization while reducing risks associated with live cell transplantation. Non-invasive bioph

Evidence level

Several human studies show positive signals, while research methods and sample sizes continue to develop.

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