The rationale for the use of vascularized nerve graft is based on the premise that a vascularized graft may provide more demyelination within the graft and subsequently more rapid regrowth of axons down its length followed by remyelination. Free non-vascularized nerve grafts have produced acceptable results if the donor nerves used are relatively thin, whereas thick nerves often develop central necrosis. An experimental technique has been devised to raise a composite neuro-venous graft and by reversing the vein component provide an arterialized composite nerve graft can be safely transferred to different parts of the body. Results have suggested that provided there is a good through in the artery and the vascular bed of the graft is small, venous drainage may not be required provided the artery remains patent. Initial results from light and electron microscopy indicate that in the majority of cases the axons reinnervated the grafts up to twice the distance of the non-vascularized nerve. Experimentally, it is concludred that the vascularized nerve is associated with more rapid axonal regeneration and remyelination than the nonvasularized cable graft.