YICROSURQERY 1 4 -1983
w h e n I started my surgical training in 195 1. surgery of peripheral nerves seemed to have reached a peak, that was hardly to be surpassed. The vast experience of World War I1 had been studied carefully in Great Britain, in Australia, and in the United States. However, many surgeons looked at the problem too optimistically. They did not really follow the cases, and they were pleased if any recovery could be detected after nerve repair, because they were convinced that with time the results would become better and would reach normal or nearly normal values. Sensibility was not regarded as important. It was the great merit of Eric Moberg to recognise the importance of sensibility and tactile gnosis.' He demonstrated that, except in children, useful sensibility did not return. This stimulated a whole generation of surgeons to think about the problem. Since then, many thiigs have changed, new techniques have been developed, and certainly an improvement has been achieved. In spite of this fact, many questions remain unanswered, and the results are far from being fully satisfactory. If I look back at the past 42 years, peripheral nerve surgery has run through three different phases, the mechanical phase, the biological phase, and the phase of neurotrophism.
MECHANICAL PHASE
Trunk-to-trunk coaptation using epineurial sutures with exact coaptation of the stumps of a transected nerve trunk, using external landmarks to avoid malrotation, was the technique of choice. Perineurial (fascicular) repair, as suggested by Langley and Hashimoto,' did not become popular. In the case of large nerve defects, the two stumps were vastly mobilized and coapted, using maximal flexion of the adjacent joints. Defects between 10 and 23 cm were managed by this technique with belief that there would be rec o v e r ~. ~ This so-called critical resection length went down with the years and reached 3-7 cm with Sir Sydney Sun-derland4 and 4-10 cm with Braun.' It is interesting to note From the oeperbnent of Plastic and ReumtwWe Surgery, 1st Surgical Clinic, University of Vienna Medical School. and Ludwig Boltzmann Institute for Experimental plastic surgery, Vienna, AusMa.