Digit or Transmetatarsal Amputation

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.
Print Friendly, PDF & Email