A Review of the Next Generation of Peripheral Nerve Repair: Bio-synthetic Guidance Conduits

Peripheral nerve injuries (PNIs) pose a major medical challenge that can often lead to long-term functional disability and chronic pain. Today, autologous nerve grafts are the gold standard for surgically bridging nerves, but have the issue of being biologically limited by both the limited availability of tissues and the morbidity of donor sites. Hollow synthetic conduits were created to passively overcome the highlighted limitations posed by nerve grafts, but a critical gap remains in their inability to actually promote and foster functional axonal regeneration in larger nerve gaps. This literature review evaluates the evolution of nerve guidance conduits and analyzes strategies of structural engineering, channel architecture, and biological scaffolding that aim to address research gaps in long-gap mechanical support and degradation control, and move beyond the limitations of passive conduits toward actual medical practice.