Nerve injuries are common in trauma surgery. Today, even under excellent conditions nerve regeneration can never achieve complete histologic and clinical recovery. Regenerative medicine of peripheral nerves is dealing with the approaches to improve nerve regeneration and to overcome extended nerve lesions without the need of harvesting autologous grafts. Nowadays, research focuses on the substitution or mimicking of cellular and neurotrophic components of the native nerve. A multitude of growth factors has proven a contributing effect on nerve regeneration. But to achieve constant supply and time related provision and proper cell-cell interactions, incorporation of living cells seems mandatory. Among others, different attempts have been the incorporation of living Schwann cells, transfected cells to overexpress favored neurotrophic proteins, and the use of stem cells to differentiate into neural cell lineages. This review provides information about the clinical background and crucial developments of tissue engineering in peripheral nerve reconstruction.