Auto Text “Insert Amputation Digit” or “Insert Amputation Transmetatarsal”

Triage

1. Should be cut fresh.
2. If received late in the day, fix in formalin.

Gross

1. Digit Amputation:
   • Measure specimen(s).
   • Measure/describe bone at resection margin (describe whether proximal bone is cut bone or articular surface, i.e. disarticulation through joint space).
   • Describe viability of tissues at the resection margin.
   • Describe any skin lesions (gangrene, lacerations, ulcerations, mummification).
   • Sections should include: 1) the soft tissue resection margin and 2) any skin lesion.
   • If osteomyelitis is suspected (by clinicians, by radiology, or by your gross exam), submit any suspicious bone, following fixation and decalcification. Usually this bone will be softened and/or discolored grey-green. It may be located under a skin ulcer or necrotic soft tissue.
     • If the suspected osteomyelitis involves the bone that has been transected by the surgeon, also submit proximal bone margin, following fixation and decalcification.
     • Conversely, a bone margin is NOT required if the marginal bone is a bone that is clearly proximal to the one involved by osteomyelitis.
     • Similarly, a bone margin is NOT required if the proximal bone is a disarticulation through joint space (i.e. there is no cut bone margin).
     • If osteomyelitis is NOT suspected, NO BONE NEEDS TO BE SUBMITTED AT ALL.
   • If bone is submitted, be sure to state “after HCl decalcification” in your cassette summary and add a Decal stain (appears as “Decalcification process” NOT “H&E Decalcification”) in Beaker. One order per container will suffice, as the only result of ordering the “stain” is to drop a billing charge.
2. Transmetatarsal Amputation:
   • Measure segment of foot and describe procedure (transmetatarsal amputation – right or left).
   • Describe skin, soft tissue, and vascular structures (if identifiable) at the resection margin.
   • Measure/describe metatarsals exposed at the surgical resection margin (describe whether proximal bone is cut bone or articular surface, i.e. disarticulation through joint space).
   • Describe and measure any skin ulcerations, lesions, gangrene, missing digits (including previous digit amputation sites).
   • Dissect and evaluate the dorsalis pedis artery.
   • Sections should include: 1) the soft tissue resection margin, 2) any stenotic artery, and 3) any skin lesion.
   • If osteomyelitis is suspected (by clinicians, by radiology, or by your gross exam), submit any suspicious bone, following fixation and decalcification. Usually this bone will be softened and/or discolored grey-green. It may be located under a skin ulcer or necrotic soft tissue.
     • If the suspected osteomyelitis involves the bone that has been transected by the surgeon, also submit proximal bone margin, following fixation and decalcification.
     • Conversely, a bone margin is NOT required if the marginal bone is a bone that is clearly proximal to the one involved by osteomyelitis.
     • Similarly, a bone margin is NOT required if the proximal bone is a disarticulation through joint space (i.e. there is no cut bone margin).
     • If osteomyelitis is NOT suspected, NO BONE NEEDS TO BE SUBMITTED AT ALL.
   • If bone is submitted, be sure to state “after HCl decalcification” in your cassette summary and add a Decal stain (appears as “Decalcification process” NOT “H&E Decalcification”) in Beaker. One order per container will suffice, as the only result of ordering the “stain” is to drop a billing charge.