Review of Gaps in the Clinical Indications and Use of Neural Conduits and Artificial Grafts for Nerve Repair and Reconstruction.

Peripheral nerve injuries remain a significant clinical challenge, with limited tools available to physicians and patients. Although autografts are the gold standard for nerve reconstruction, they are limited by donor-site morbidity and availability. Commercially available nerve guidance conduits offer alternatives, yet their clinical application remains largely restricted to short nerve gaps with limited success beyond 1 cm. This review provides a summary of the clinical studies on nerve injury repair using commercial nerve guidance conduits and discusses the shortcomings of such devices, including suboptimal mechanical properties, lack of internal guidance structures and bioactivity, and insufficient clinical data. To address these challenges, emerging innovations, such as biofunctionalized materials, conductive scaffolds, and topographically engineered architectures, are readily being explored to improve regenerative outcomes following neural injury. Overall, this work highlights the gaps in commercial devices utilized clinically and brings attention to the evolving landscape of biomaterials research that can transform clinical nerve repair.