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The shift from evaluation of the nerve injury using macroscopic techniques of exploration and external neurolysis to microscopic interrogation, interfascicular dissection, and internal neurolysis along with the use of intraoperative electrophysiology were important advances of the past 50 years. By the late 20th century, the advent and popularization of interfascicular nerve grafting techniques heralded a major advance in nerve reconstruction and allowed good outcomes to be achieved in a large percentage of nerve injury repair cases. In the past 2 decades, there has been a paradigm shift in surgical nerve repair, wherein surgeons are not only directing the repair at the injury zone, but also are deliberately performing distal-targeted nerve transfers as a preferred alternative in an attempt to restore function. The peripheral rewiring approach allows the surgeon to convert a very proximal injury with long regeneration distances and (often) uncertain outcomes to a distal injury and repair with a greater potential of regenerative success and functional recovery. Nerve transfers, originally performed as a salvage procedure for severe brachial plexus avulsion injuries, are now routinely done for various less severe brachial plexus injuries and many other proximal nerve injuries, with reliably good to even excellent results. The outcomes from nerve transfers for select clinical nerve injury are emphasized in this review. Extension of the rewiring paradigm with nerve transfers for CNS lesions such as spinal cord injury and stroke are showing great potential and promise. Cortical reeducation is required for success, and an emerging field of rehabilitation and restorative neurosciences is evident, which couples a nerve transfer procedure to robotically controlled limbs and mind-machine interfacing. The future for peripheral nerve repair has never been more exciting.<\/jats:p>","DOI":"10.3171\/2018.11.jns181520","type":"journal-article","created":{"date-parts":[[2019,3,6]],"date-time":"2019-03-06T05:28:29Z","timestamp":1551850109000},"page":"675-685","source":"Crossref","is-referenced-by-count":73,"title":["Surgery for nerve injury: current and future perspectives"],"prefix":"10.3171","volume":"130","author":[{"given":"Rajiv","family":"Midha","sequence":"first","affiliation":[{"name":"Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joey","family":"Grochmal","sequence":"additional","affiliation":[{"name":"Neurosurgery, University Medical Center, Lubbock, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"195","DOI":"10.3171\/2014.9.JNS132823","article-title":"Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques","volume":"122","author":"Ali ZS","year":"2015","unstructured":"Ali ZS, Heuer GG, Faught RW, Kaneriya SH, Sheikh UA, Syed IS, : Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques. 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