Digit
Author:
Mikael Häggström [note 1]
For an amputated toe:
Contents
Comprehensiveness
On this resource, the following formatting is used for comprehensiveness:
- Minimal depth
- (Moderate depth)
- ((Comprehensive))
- Other legend
<< Decision needed between alternatives separated by / signs >>
{{Common findings / In case of findings}}
[[Comments]]
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Gross processing
Either before or after a general inspection, fix the toe in formalin, such as overnight, and then leaving it for 5-6 hours in a relatively strong decalcifying solution.
- Measure length and average diameter
- Determine the anatomic location of the cut (proximal to the distal phalanx, middle phalanx, metatarsal phalangeal joint etc).
- Ink the surgical margins differently for soft tissue and bony margin.
Tissue selection
Sections for microscopy are taken as follows:
For amputations disarticulated at the joint:
- Perpendicular sections of articular cartilage and adjacent bone. State which bone in key of sections
For amputations resected by cutting across bone:
- Ink the bone at the proximal margin, submit perpendicular section of bony margin.
- Skin and soft tissues at proximal margin.
- If margin is close to gangrene- perpendicular sections
- If far, submit enface
Gangrene and/or suspected osteomyelitis:
- Submit cross sections of each bone with associated ulcer and/or gangrene if appropriate, generally sagittal/longitudinal. Attempt to include the longitudinal distance to the proximal bony margin/cartilage.
Gross report
Example:
(A. Labeled - ___. The specimen is received in formalin and consists of an amputated toe.) The toe measures ___ cm in length and ___ cm in average diameter. The toe is resected ___ [[location]]. {{The proximal ___ cm of the specimen is not covered by skin and soft tissue.}} The skin and soft tissue margins appear <viable / necrotic>. The skin surface of the toe appears ___ {{and displays an (ulcerated/necrotic/gangrenous) lesion, cm from the cutaneous margin}}. The nail is <color/thickened/absent/necrotic>. The soft tissue surgical margin is inked blue [[for example]], and the bony surgical margin of the ___ [[specific bone involved]] is inked green [[for example]]. On cut sections, the bone subjacent to the ulcer shows no gross abnormalities. Representative sections are submitted for microscopic examination in ___ cassettes following decalcification. |
Microscopic examination
Mainly, detect the presence of:
Osteomyelitis, mainly by neutrophils in the stroma. Further information: Osteomyelitis
- Example
(A. Left third toe, amputation:) Toe with ulcer and osteomyelitis. Osteomyelitis involves the distal phalanx, middle phalanx and proximal phalanx. Osteomyelitis is 2.0 cm from the proximal articular surface of the proximal phalanx. |
See also
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
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References
Image sources