The current philosophy of the microneurosurgical management of nerve injury is reviewed. Controversial techniques such as internal neurolysis are discussed as is the surgical dilemma of the neuroma incontinuity.Nerve regeneration is under the mechanical influence of contract guidance and the neurobiological influence of neurotropism and neurotrophism, or, as we have wined it, neurotrop(h)ism. The wncepts of neurotrop(h)ism and wntact guidance axe discussed, emphasizing the potential impoxtance of neurobiology in determining functional outwme following nerve repair. Finally, the interaction of the immune system and nerve regeneration is discussed.