Abstract: A (very) brief history of tension in nerve repair: Successful nerve repair is achieved by conveying as many axons successfully to their targets as possible. Typically, this is best achieved through a direct end-to-end repair under minimal tension (Millesi, 1986). However, this is not feasible in most cases of trauma, where a segment of tissue damage must be excised and overcome. This has most commonly been addressed with the use of nerve grafts to bridge the gap. Autologous nerve grafts are considered the gold standard, with allograft or synthetic substitutes demonstrating some success over shorter distances. Despite their utility, autologous grafts pose challenges of their own. These include functional deficit in the donor distribution (typically sensory), extended operative duration, additional scarring, and a lack of intrinsic blood supply. They are also a poor anatomical match for the stumps being bridged, both internally (disparate neuronal size and composition) as well as externally (often requiring cabled bundles to approximate the caliber of the nerve being repaired). Finally, unlike end-to-end repairs, autologous grafts also require axons to traverse a second repair interface, where a large proportion of axons are lost across the anatomical discontinuity.