Digit: Difference between revisions
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*Determine the anatomic '''location''' of the cut (proximal to the distal phalanx, middle phalanx, metatarsal phalangeal joint etc). | *Determine the anatomic '''location''' of the cut (proximal to the distal phalanx, middle phalanx, metatarsal phalangeal joint etc). | ||
*Look at '''soft tissue margins''' whether they look viable or necrotic. | *Look at '''soft tissue margins''' whether they look viable or necrotic. | ||
*Look at the | *Look at the '''skin surface'''. For any lesion such as ulcerated or necrotic one, measure the distance to the nearest soft tissue margin. | ||
*'''[[Inking|Ink]]''' the surgical margins differently for soft tissue and bony margin. | *'''[[Inking|Ink]]''' the surgical margins differently for soft tissue and bony margin. | ||
[[File:Gross pathology of amputated finger after longitudinal cutting.jpg|thumb|210px|Amputated finger after longitudinal split.]] | |||
*'''Split''' the digit longitudinally, either in the midline or at the closest margin between any ulcer and the soft tissue margin. | *'''Split''' the digit longitudinally, either in the midline or at the closest margin between any ulcer and the soft tissue margin. | ||
*Let the tissue fix in formalin and then use a relatively strong '''decalcifying''' agent, usually at least 5-6 hours. | *Let the tissue fix in formalin and then use a relatively strong '''decalcifying''' agent, usually at least 5-6 hours. | ||
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*Submit cross sections of each '''bone''' with associated ulcer and/or gangrene if appropriate, generally sagittal/longitudinal. Attempt to include the longitudinal distance from potential osteomyelitis to the proximal bony margin/cartilage. | *Submit cross sections of each '''bone''' with associated ulcer and/or gangrene if appropriate, generally sagittal/longitudinal. Attempt to include the longitudinal distance from potential osteomyelitis to the proximal bony margin/cartilage. | ||
*'''Skin and soft tissues''' at proximal margin. | *'''Skin and soft tissues''' at proximal margin. | ||
:*If margin is close to gangrene | :*If margin is close to gangrene: perpendicular sections | ||
:*If far, submit enface | :*If far, submit enface | ||
<gallery mode=packed heights=180> | |||
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 enface soft tissue margins because of no proximity to gangrene. | |||
</gallery> | |||
===Gross report=== | ===Gross report=== | ||