Difference between revisions of "Digit"
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| {{Moderate-begin}}A. Labeled - ___. The specimen is received in formalin and consists of an amputated toe.{{Moderate-end}} The toe measures ___ cm in length and ___ cm in average diameter. The toe 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 of the toe appears ___ {{Finding-begin}}and displays an (ulcerated/necrotic/gangrenous) lesion, cm from the cutaneous margin{{Finding-end}}. The nail is <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 toe.{{Moderate-end}} The toe measures ___ cm in length and ___ cm in average diameter. The toe 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 of the toe appears ___ {{Finding-begin}}and displays an (ulcerated/necrotic/gangrenous) lesion, cm from the cutaneous margin{{Finding-end}}. The nail is <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. | ||
+ | |} | ||
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+ | ==Microscopic examination== | ||
+ | Mainly, detect the presence of: | ||
+ | <gallery mode=packed> | ||
+ | File:Histopathology of acute osteomyelitis.jpg|'''[[Osteomyelitis]]''', if present, determine its extent, particularly compared to the bony surgical or articular margin. | ||
+ | </gallery> | ||
+ | |||
+ | ;Example | ||
+ | {|class=wikitable | ||
+ | | {{Moderate-begin}}A. Left third toe, amputation:{{Moderate-end}}<br>Toe with ulcer and osteomyelitis. Osteomyelitis involvesthe distal phalanx, middle phalanx and proximal phalanx.<br>Osteomyelitis is 2.0 cm from the proximal articular surface of the proximal phalanx. | ||
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Revision as of 16:41, 23 November 2020
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]]
Link to another page
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.
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:
- 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:
(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, if present, determine its extent, particularly compared to the bony surgical or articular margin.
- Example
(A. Left third toe, amputation:) Toe with ulcer and osteomyelitis. Osteomyelitis involvesthe 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.
Main page
References
Image sources