Mixed nerve suture facilitated by enzyme-staining techniques.

Identification of motor and sensory fascicles to correctly match the motor and sensory fascicles helps surgeons to correctly align nerve stumps. Motor fibers, with their high cholinesterase activity, can be differentiated from sensory fibers. I developed a new modification that requires less than 1 hour and shows clearer differentiation compared with other histochemical techniques. In my clinical research, proximal stumps can be stained as long as 16 months after injury, however, distal stumps cannot be stained after 5 days. After 5 days, this staining could provide useful proximal information and distal fascicles may be identified by anatomic or topographical knowledge. I think this staining is especially useful in proximal nerve lesions and nerve injuries that require nerve graft within 4 days after injury. Also, this technique is useful in functioning muscle transfer to find motor fascicles and, in a sensate flap, to identify the sensory fascicle.