Digit: Difference between revisions

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:*If margin is close to gangrene: perpendicular sections

:*If far, submit {{en face}}

*If you receive a '''separate''' thin or discoid bone slice, it is generally an additional bone margin. Preferably, have this decalcified and processed promptly, so that it may be used to make a preliminary report as to whether it is involved even before the main specimen is processed.

File:Gross pathology of amputated finger sections in cassette.jpg|Contiguous longitudinal sections from a finger with suspected osteomyelitis. {{Moderate-begin}}Ensure that each slice that contains two or more bones can be oriented<ref group=notes>Orientation can be made as follows: - Anatomic orientation, as in this example where the middle slice can be anatomically oriented by the convexity of the proximal phalangeal head, or a part of the nail distally. - [[Inking]] one side. - Avoiding multiple bones in one slice by cutting the soft tissue at joints so that the bones can be separated and put in different cassettes</ref>{{Moderate-end}}

File:Gross pathology of amputated finger sections in cassette.jpg|Contiguous longitudinal sections from a finger with suspected osteomyelitis.

File:Gross pathology of soft tissue margins of an amputated finger.jpg|Finger with en face soft tissue margins because of no proximity to gangrene.

</gallery>

At least if osteomyelitis is suspected, [[ink]] all proximal {{moderate-begin}}and/{{moderate-end}}or distal cut surfaces {{moderate-begin}}differentially{{Moderate-end}} of each slice, so that the pieces can be oriented, and the distance between osteomyelitis and the surgical margin can be estimated. The exception is where pieces can most definitely be anatomically oriented, such as the presence of a nail distally.

===Gross report===

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File:Histopathology of acute osteomyelitis.jpg|'''[[Osteomyelitis]]''', mainly by neutrophils in the stroma. {{further|Osteomyelitis|linebreak=no}}

File:Histopathology of ischemic necrotic gangrene with neutrophils, present at inked soft tissue margin.jpg|Significant pathologies at the margins, such as necrosis of soft tissue margins as shown with neutrophil involvement.

</gallery>

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| {{Moderate-begin}}A. Left third toe, amputation:{{Moderate-end}} Toe with ulcer, gangrene 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. {{Moderate-begin}}The skin and soft tissue at the surgical margin appear viable.{{Moderate-end}}

|}

==See also==

*[[Soft tissues]]

</noinclude>

@@ Line 31: / Line 31: @@
 :*If margin is close to gangrene: perpendicular sections
 :*If far, submit {{en face}}
+*If you receive a '''separate''' thin or discoid bone slice, it is generally an additional bone margin. Preferably, have this decalcified and processed promptly, so that it may be used to make a preliminary report as to whether it is involved even before the main specimen is processed.
 <gallery mode=packed heights=180>
-File:Gross pathology of amputated finger sections in cassette.jpg|Contiguous longitudinal sections from a finger with suspected osteomyelitis. {{Moderate-begin}}Ensure that each slice that contains two or more bones can be oriented<ref group=notes>Orientation can be made as follows:<br>- Anatomic orientation, as in this example where the middle slice can be anatomically oriented by the convexity of the proximal phalangeal head, or a part of the nail distally.<br>- [[Inking]] one side.<br>- Avoiding multiple bones in one slice by cutting the soft tissue at joints so that the bones can be separated and put in different cassettes</ref>{{Moderate-end}}
+File:Gross pathology of amputated finger sections in cassette.jpg|Contiguous longitudinal sections from a finger with suspected osteomyelitis.
 File:Gross pathology of soft tissue margins of an amputated finger.jpg|Finger with en face soft tissue margins because of no proximity to gangrene.
 </gallery>
+At least if osteomyelitis is suspected, [[ink]] all proximal {{moderate-begin}}and/{{moderate-end}}or distal cut surfaces {{moderate-begin}}differentially{{Moderate-end}} of each slice, so that the pieces can be oriented, and the distance between osteomyelitis and the surgical margin can be estimated. The exception is where pieces can most definitely be anatomically oriented, such as the presence of a nail distally.
 ===Gross report===
@@ Line 49: / Line 51: @@
 <gallery mode=packed>
 File:Histopathology of acute osteomyelitis.jpg|'''[[Osteomyelitis]]''', mainly by neutrophils in the stroma. {{further|Osteomyelitis|linebreak=no}}
+File:Histopathology of ischemic necrotic gangrene with neutrophils, present at inked soft tissue margin.jpg|Significant pathologies at the margins, such as necrosis of soft tissue margins as shown with neutrophil involvement.
 </gallery>
@@ Line 56: / Line 59: @@
 | {{Moderate-begin}}A. Left third toe, amputation:{{Moderate-end}}<br>Toe with ulcer, gangrene and osteomyelitis. Osteomyelitis involves the distal phalanx, middle phalanx and proximal phalanx.<br>Osteomyelitis is 2.0 cm from the proximal articular surface of the proximal phalanx.<br>{{Moderate-begin}}The skin and soft tissue at the surgical margin appear viable.{{Moderate-end}}
 |}
+<noinclude>
 ==See also==
 *[[Soft tissues]]
 {{Bottom}}
+</noinclude>

Digit: Difference between revisions

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