Peripheral nerve injury results in significant functional loss in the affected limb. Prompt recognition and reconstruction of the injured nerve is believed to produce the best possible functional outcome in such situations. Neglected nerve injuries pose a challenge to the treating surgeon. Causes of neglect include failure to recognize the deficit at the primary treatment facility, lack of access to qualified doctors or ignorance by the patient of the professional advice. Clinical presentation, apart from the typical motor, sensory and autonomic neurological deficit includes complications of neglect namely fixed deformities, non healing ulcers and severe muscular atrophy. There seems to be no specified terminology for neglected nerve injuries treated several months later. Management has to be customized in accordance with the principles of nerve repair. Surgical options for functional restoration in neglected peripheral nerve injuries are three fold: nerve reconstruction, tendon transfers and early combination of both nerve reconstruction and tendon transfer. Nerve reconstruction by neurorrhaphy or by nerve grafting may be considered in cases where the time elapsed is within limits conducive to motor recovery because all the three upper limb nerves have important motor function. Tendon transfer, tenodesis and arthrodesis in isolation or in combination are suitable to all neglected nerve injuries more than two years old. Recently it has been suggested that early tendon transfers when combined with neurorrhaphy have improved outcomes. Supportive treatment with the help of occupational/physiotherapy sessions is essential to keep the affected limb free of any deformity, joints supple and hand and feet ulcer free.