Difference between revisions of "Amputation"

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(Expanded)
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==Gross processing==
 
==Gross processing==
Either before or after a general inspection, fix the body part in formalin, such as overnight for digits, and then leaving it for 5-6 hours in a relatively strong '''decalcifying''' solution.
+
For relatively small amputations (up to trans-metatarsal amputations), fix the body part in formalin, either before or after a general inspection. It can be done overnight for digits, and then leaving it for 5-6 hours in a relatively strong '''decalcifying''' solution.
  
 
*Measure '''length''' and average '''diameter'''
 
*Measure '''length''' and average '''diameter'''
 
*Determine the anatomic '''location''' of the cut.
 
*Determine the anatomic '''location''' of the cut.
*Ink the surgical margins differently for soft tissue and bony margin, where samples are to be taken.
+
*At least for amputated digits, ink the surgical margins differently for soft tissue and bony margin, where samples are to be taken.
  
 
'''Sections''' for microscopy are taken as follows:
 
'''Sections''' for microscopy are taken as follows:
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For amputations resected by cutting across bone:
 
For amputations resected by cutting across bone:
*Ink the bone at the proximal margin, submit perpendicular section of bony margin.
+
*For at least amputated digits, ink the bone at the proximal margin, submit perpendicular section of bony margin.
 
*Skin and soft tissues at proximal margin.
 
*Skin and soft tissues at proximal margin.
 
:*If margin is close to gangrene- perpendicular sections
 
:*If margin is close to gangrene- perpendicular sections
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===Gross report===
 
===Gross report===
Example:
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Example for digits:
 
{|class=wikitable
 
{|class=wikitable
 
| {{Moderate-begin}}A. Labeled - ___. The specimen is received in formalin and consists of an amputated __.{{Moderate-end}} It measures ___ cm in length and ___ cm in average diameter. It is resected ___ {{Comment-begin}}location{{Comment-end}}. {{Finding-begin}}The proximal ___ cm of the specimen is not covered by skin and soft tissue.{{Finding-end}} The skin and soft tissue margins appear <viable / necrotic>. The skin surface appears ___ {{Finding-begin}}and displays an (ulcerated/necrotic/gangrenous) lesion, cm from the cutaneous margin{{Finding-end}}. The nail(s) is/are <color/thickened/absent/necrotic>. The soft tissue surgical margin is inked blue {{Comment-begin}}for example{{Comment-end}}, and the bony surgical margin of the ___ {{Comment-begin}}specific bone involved{{Comment-end}} is inked green {{Comment-begin}}for example{{Comment-end}}. On cut sections, the bone subjacent to the ulcer shows no gross abnormalities. Representative sections are submitted for microscopic examination in ___ cassettes following decalcification.
 
| {{Moderate-begin}}A. Labeled - ___. The specimen is received in formalin and consists of an amputated __.{{Moderate-end}} It measures ___ cm in length and ___ cm in average diameter. It is resected ___ {{Comment-begin}}location{{Comment-end}}. {{Finding-begin}}The proximal ___ cm of the specimen is not covered by skin and soft tissue.{{Finding-end}} The skin and soft tissue margins appear <viable / necrotic>. The skin surface appears ___ {{Finding-begin}}and displays an (ulcerated/necrotic/gangrenous) lesion, cm from the cutaneous margin{{Finding-end}}. The nail(s) is/are <color/thickened/absent/necrotic>. The soft tissue surgical margin is inked blue {{Comment-begin}}for example{{Comment-end}}, and the bony surgical margin of the ___ {{Comment-begin}}specific bone involved{{Comment-end}} is inked green {{Comment-begin}}for example{{Comment-end}}. On cut sections, the bone subjacent to the ulcer shows no gross abnormalities. Representative sections are submitted for microscopic examination in ___ cassettes following decalcification.

Revision as of 13:09, 8 July 2021

Author: Mikael Häggström [notes 1]
This article deals with surgical (non-traumatic) amputations:

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]]
Link to another page

More specific guidelines

Gross processing

For relatively small amputations (up to trans-metatarsal amputations), fix the body part in formalin, either before or after a general inspection. It can be done overnight for digits, 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.
  • At least for amputated digits, ink the surgical margins differently for soft tissue and bony margin, where samples are to be taken.

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

Gangrene:

  • Submit cross sections of each bone with associated gangrene if appropriate, generally sagittal/longitudinal. State what bone in the key of sections.

For amputations resected by cutting across bone:

  • For at least amputated digits, 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

Gross report

Example for digits:

(A. Labeled - ___. The specimen is received in formalin and consists of an amputated __.) It measures ___ cm in length and ___ cm in average diameter. It 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 appears ___ {{and displays an (ulcerated/necrotic/gangrenous) lesion, cm from the cutaneous margin}}. The nail(s) is/are <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.

See also

Notes

  1. 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.

Main page

References