Peripheral nerve injuries, particularly those involving extensive damage where direct suture repair is not feasible, represent significant challenges in neurosurgery. Autologous nerve grafts remain the gold standard for reconstruction, but innovative techniques, such as nerve and tendon transfers, along with the integration of bionic and robotic technologies, have improved patient outcomes. This chapter focuses on the latest advancements in peripheral nerve surgery, emphasizing surgical innovations and alternative therapeutic options for cases where traditional treatments are ineffective, especially in brachial plexus and upper limb injuries. These advancements, including bionic devices and tissue engineering, offer a profound promise in improving patients’ quality of life. Continued research and technological refinement are essential to expanding these methods and benefiting a broader patient population with complex nerve injuries.