Although open and endoscopic techniques for carpal tunnel release can provide excellent results, neither technique has demonstrated clinical superiority. A permanent nerve injury remains the most devastating complication regardless of the technique used. Symptoms in carpal tunnel syndrome recur in up to 30% of patients, usually secondary to scarring of the median nerve. Repeated nerve decompression alone does not always provide satisfactory results in patients with recalcitrant carpal tunnel syndrome. Supplementary techniques with either biologic or synthetic adhesion barriers can be used to cover the nerve, improving functional recovery and preventing recurrent scarring. Direct end-to-end repair without tension remains the gold standard treatment of peripheral nerve lacerations. When primary repair is not possible, biologic or synthetic nerve conduits and nerve allografts are an alternative to autografts. Future advances in bioengineering and better understanding of nerve biology combined with randomized, multicenter, larger studies may lead to the optimal method of peripheral nerve reconstruction.