Dr. Mackinnon's thoughtful paper on the "wandering nerve A concept that the author does not discuss, but that graft" is based on the concept that the microenvironment of relates to her work, concerns the neurotrophic effect on innervated muscle somehow modifies neuroma formation; nerve regeneration when nerve grafts are connected distally it is smaller, with fewer nerve fibers, which are less well to a nerve or when they are not. The poorer regeneration myelinated. She hypothesizes that the innervated muscle is along unconnected distal nerves may also have a beneficial a non-neurotrophic target compared with subcutaneous tis-effect in this case. sue and denervated skin. The end of the nerve graft is also, Finally, the author suggests the potential use of nerve in this case, placed in a large muscle with minimal excur-allografts, which seem altogether appropriate, but why not sion; tissue that is less available in the hand, where, she also consider other conduits as well (e.g., veins)? These noted, direct implantation of a cut nerve end was less alternate conduits may have particular merit, because, pasuccessful.
tients who are "painful neuroma prone" also tend, in my experience, to have problems with nerve graft donor sites and may trade a problem in one area for one in another.