Toe

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Author: Mikael Häggström [notes 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]]

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.

Tissue selection

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

For amputations resected by cutting across bone:

  • Ink the bone at the proximal margin, submit perpendicular section of bony margin.

Gangrene and/or suspected osteomyelitis:

  • 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.
  • 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.
Key to sections:
  1. Longitudinal section through distal phalanx
  2. Longitudinal section through proximal phalanx
  3. Skin and soft tissues at proximal margin, submitted en face

Microscopic examination

Mainly, detect the presence of:

Microscopic report

Example:

(A. Left third toe, amputation:)
Toe with ulcer 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.

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.

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References