Although much progress has been made, current treatments of peripheral nerve injury often result in only partial recovery. Many methods have been used to improve the surgical exploration for injured nerve repair. However, much less is known about the involvement of complex neurochemical interactions. Several neurotrophic factors have been shown to play an essential trophic role in the development, maintenance, and regulation of neuronal function. These include nerve growth factor (NGF) and several recently identified members of the NGF family. In this article we give an overview of the process of peripheral nerve injury and regeneration, review the roles of Schwann cells and neurotrophic factors, and summarize perspectives on how gene therapy with viral vectors and cell-mediated DNA strand technology may be used to improve treatment of peripheral nerve injuries.