Whereas minor injuries to peripheral nerves merely lead to a circumscribed damage of the myelin sheath which is completely healed within 3 months, penetrating injuries lead to degeneration of the distal axonal fragment (Waller degeneration) and simultaneously to time-dependent alterations in the effector organs, in the perikarya in the medulla and spinal ganglia as well as in the brain. Animal experimental studies and also findings in humans confirm that the conditions for regeneration of nerve fibers are most favorable in the first days and weeks following injury. Therefore, for optimal therapy it should be clarified as early as possible whether there is a chance for reinnervation using exclusively conservative therapy or whether an operative reconstruction is necessary due to the severity of structural damage. Imaging investigation procedures, such as neurosonography and magnetic resonance (MR) neurography can provide decisive information on this aspect. As a rule, the decision on the indications for a nerve operation should be made within the first 3 months. Even with optimal therapy the healing process of severe neural injuries is often unsatisfactory. For some years novel procedures for improvement of nerve regeneration have been tested in animal experiments which involve totally different points in the healing process. It is hoped that with these approaches procedures for improvement in the treatment of nerve injuries in humans can be developed in the near future.