Difference between revisions of "Amputation"
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==Gross processing== | ==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''' | *Measure '''length''' and average '''diameter''' | ||
*Determine the anatomic '''location''' of the cut. | *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: | '''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: | ||
− | * | + | *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: | + | 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 14:09, 8 July 2021
Author:
Mikael Häggström [note 1]
This article deals with surgical (non-traumatic) amputations:
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]]
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
- ↑ 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
Image sources