Confined surface gradients consisting of polymer brushes have great potentials in various applications such as microfluidic devices, sensors, and biophysical research. Among the available fabrication approaches, nanolithographies combined with self-assembled monolayers and surface-initiated polymerization have became powerful tools to engineer confined gradients or predefined complex gradients on the nanometer size. In this tutorial review, we mainly highlight the research progress of the fabrication of confined polymer brush gradients by using electron beam, laser, and probe-based nanolithographies and the physical base for these approaches. The application of these polymer brush gradients in biomedical research is also addressed.