Digit - Revision history

Mikael Häggström: /* Microscopic examination */ +Margins

2024-06-14T21:08:34Z

Microscopic examination: +Margins

← Older revision		Revision as of 17:08, 14 June 2024
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	<gallery mode=packed>		<gallery mode=packed>
	File:Histopathology of acute osteomyelitis.jpg\|'''[[Osteomyelitis]]''', mainly by neutrophils in the stroma. {{further\|Osteomyelitis\|linebreak=no}}		File:Histopathology of acute osteomyelitis.jpg\|'''[[Osteomyelitis]]''', mainly by neutrophils in the stroma. {{further\|Osteomyelitis\|linebreak=no}}
			File:Histopathology of ischemic necrotic gangrene with neutrophils, present at inked soft tissue margin.jpg\|Significant pathologies at the margins, such as necrosis of soft tissue margins as shown with neutrophil involvement.
	</gallery>		</gallery>

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	\|}		\|}
	<noinclude>		<noinclude>

	==See also==		==See also==
	*[[Soft tissues]]		*[[Soft tissues]]
	{{Bottom}}		{{Bottom}}
	</noinclude>		</noinclude>

Mikael Häggström: /* Intitial processing */ Separate

2024-03-08T18:37:35Z

Intitial processing: Separate

← Older revision		Revision as of 14:37, 8 March 2024
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	:*If margin is close to gangrene: perpendicular sections		:*If margin is close to gangrene: perpendicular sections
	:*If far, submit {{en face}}		:*If far, submit {{en face}}
			*If you receive a '''separate''' thin or discoid bone slice, it is generally an additional bone margin. Preferably, have this decalcified and processed promptly, so that it may be used to make a preliminary report as to whether it is involved even before the main specimen is processed.
	<gallery mode=packed heights=180>		<gallery mode=packed heights=180>
	File:Gross pathology of amputated finger sections in cassette.jpg\|Contiguous longitudinal sections from a finger with suspected osteomyelitis.		File:Gross pathology of amputated finger sections in cassette.jpg\|Contiguous longitudinal sections from a finger with suspected osteomyelitis.

Mikael Häggström: Noinclude

2022-08-01T22:52:53Z

Noinclude

← Older revision		Revision as of 18:52, 1 August 2022
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	\| {{Moderate-begin}}A. Left third toe, amputation:{{Moderate-end}}<br>Toe with ulcer, gangrene and osteomyelitis. Osteomyelitis involves the distal phalanx, middle phalanx and proximal phalanx.<br>Osteomyelitis is 2.0 cm from the proximal articular surface of the proximal phalanx.<br>{{Moderate-begin}}The skin and soft tissue at the surgical margin appear viable.{{Moderate-end}}		\| {{Moderate-begin}}A. Left third toe, amputation:{{Moderate-end}}<br>Toe with ulcer, gangrene and osteomyelitis. Osteomyelitis involves the distal phalanx, middle phalanx and proximal phalanx.<br>Osteomyelitis is 2.0 cm from the proximal articular surface of the proximal phalanx.<br>{{Moderate-begin}}The skin and soft tissue at the surgical margin appear viable.{{Moderate-end}}
	\|}		\|}
			<noinclude>
	==See also==		==See also==
	*[[Soft tissues]]		*[[Soft tissues]]
	{{Bottom}}		{{Bottom}}
			</noinclude>

Mikael Häggström: /* Tissue selection */ Rewording

2022-06-22T16:48:27Z

Tissue selection: Rewording

← Older revision		Revision as of 12:48, 22 June 2022
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	:*If far, submit {{en face}}		:*If far, submit {{en face}}
	<gallery mode=packed heights=180>		<gallery mode=packed heights=180>
	File:Gross pathology of amputated finger sections in cassette.jpg\|Contiguous longitudinal sections from a finger with suspected osteomyelitis. {{Moderate-begin}}Ensure that each slice that contains two or more bones can be oriented<ref group=notes>Orientation can be made as follows:<br>- Anatomic orientation, as in this example where the middle slice can be anatomically oriented by the convexity of the proximal phalangeal head, or a part of the nail distally.<br>- [[Inking]] one side.<br>- Avoiding multiple bones in one slice by cutting the soft tissue at joints so that the bones can be separated and put in different cassettes</ref>{{Moderate-end}}		File:Gross pathology of amputated finger sections in cassette.jpg\|Contiguous longitudinal sections from a finger with suspected osteomyelitis.
	File:Gross pathology of soft tissue margins of an amputated finger.jpg\|Finger with en face soft tissue margins because of no proximity to gangrene.		File:Gross pathology of soft tissue margins of an amputated finger.jpg\|Finger with en face soft tissue margins because of no proximity to gangrene.
	</gallery>		</gallery>
			At least if osteomyelitis is suspected, [[ink]] all proximal {{moderate-begin}}and/{{moderate-end}}or distal cut surfaces {{moderate-begin}}differentially{{Moderate-end}} of each slice, so that the pieces can be oriented, and the distance between osteomyelitis and the surgical margin can be estimated. The exception is where pieces can most definitely be anatomically oriented, such as the presence of a nail distally.

	===Gross report===		===Gross report===

Mikael Häggström: /* Tissue selection */ Nail

2021-09-23T23:10:29Z

Tissue selection: Nail

← Older revision		Revision as of 19:10, 23 September 2021
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	:*If far, submit {{en face}}		:*If far, submit {{en face}}
	<gallery mode=packed heights=180>		<gallery mode=packed heights=180>
	File:Gross pathology of amputated finger sections in cassette.jpg\|Contiguous longitudinal sections from a finger with suspected osteomyelitis. {{Moderate-begin}}Ensure that each slice that contains two or more bones can be oriented<ref group=notes>Orientation can be made as follows:<br>- Anatomic orientation, as in this example where the middle slice can be anatomically oriented by ~~for example the~~ the convexity of the proximal phalangeal head.<br>- [[Inking]] one side.<br>- Avoiding multiple bones in one slice by cutting the soft tissue at joints so that the bones can be separated and put in different cassettes</ref>{{Moderate-end}}		File:Gross pathology of amputated finger sections in cassette.jpg\|Contiguous longitudinal sections from a finger with suspected osteomyelitis. {{Moderate-begin}}Ensure that each slice that contains two or more bones can be oriented<ref group=notes>Orientation can be made as follows:<br>- Anatomic orientation, as in this example where the middle slice can be anatomically oriented by the convexity of the proximal phalangeal head, or a part of the nail distally.<br>- [[Inking]] one side.<br>- Avoiding multiple bones in one slice by cutting the soft tissue at joints so that the bones can be separated and put in different cassettes</ref>{{Moderate-end}}
	File:Gross pathology of soft tissue margins of an amputated finger.jpg\|Finger with en face soft tissue margins because of no proximity to gangrene.		File:Gross pathology of soft tissue margins of an amputated finger.jpg\|Finger with en face soft tissue margins because of no proximity to gangrene.
	</gallery>		</gallery>

Mikael Häggström: /* Tissue selection */ Noted

2021-09-23T23:09:26Z

Tissue selection: Noted

← Older revision		Revision as of 19:09, 23 September 2021
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	:*If far, submit {{en face}}		:*If far, submit {{en face}}
	<gallery mode=packed heights=180>		<gallery mode=packed heights=180>
	File:Gross pathology of amputated finger sections in cassette.jpg\|Contiguous longitudinal sections from a finger with suspected osteomyelitis. {{Moderate-begin}}~~Here~~ the middle ~~piece~~ can be anatomically oriented by for example the the convexity of the proximal phalangeal head~~, but in cases where it may not be evident, ink~~ one side ~~for orientation~~.{{Moderate-end}}		File:Gross pathology of amputated finger sections in cassette.jpg\|Contiguous longitudinal sections from a finger with suspected osteomyelitis. {{Moderate-begin}}Ensure that each slice that contains two or more bones can be oriented<ref group=notes>Orientation can be made as follows:<br>- Anatomic orientation, as in this example where the middle slice can be anatomically oriented by for example the the convexity of the proximal phalangeal head.<br>- [[Inking]] one side.<br>- Avoiding multiple bones in one slice by cutting the soft tissue at joints so that the bones can be separated and put in different cassettes</ref>{{Moderate-end}}
	File:Gross pathology of soft tissue margins of an amputated finger.jpg\|Finger with en face soft tissue margins because of no proximity to gangrene.		File:Gross pathology of soft tissue margins of an amputated finger.jpg\|Finger with en face soft tissue margins because of no proximity to gangrene.
	</gallery>		</gallery>

Mikael Häggström: Wording

2021-09-23T19:10:59Z

Wording

Mikael Häggström: /* Tissue selection */ corrected

2021-09-23T19:06:29Z

Tissue selection: corrected

← Older revision		Revision as of 15:06, 23 September 2021
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	:*If far, submit {{en face}}		:*If far, submit {{en face}}
	<gallery mode=packed heights=180>		<gallery mode=packed heights=180>
	File:Gross pathology of amputated finger sections in cassette.jpg\|Contiguous longitudinal sections from a finger with suspected osteomyelitis. {{Moderate-begin}}Here the middle piece can be anatomically oriented by for example the the convexity of the ~~middle~~ phalangeal head, but in cases where it may not be evident, ink one side for orientation.{{Moderate-end}}		File:Gross pathology of amputated finger sections in cassette.jpg\|Contiguous longitudinal sections from a finger with suspected osteomyelitis. {{Moderate-begin}}Here the middle piece can be anatomically oriented by for example the the convexity of the proximal phalangeal head, but in cases where it may not be evident, ink one side for orientation.{{Moderate-end}}
	File:Gross pathology of soft tissue margins of an amputated finger.jpg\|Finger with en face soft tissue margins because of no proximity to gangrene.		File:Gross pathology of soft tissue margins of an amputated finger.jpg\|Finger with en face soft tissue margins because of no proximity to gangrene.
	</gallery>		</gallery>

Mikael Häggström: /* Tissue selection */ Orientation

2021-09-23T19:05:24Z

Tissue selection: Orientation

← Older revision		Revision as of 15:05, 23 September 2021
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	:*If far, submit {{en face}}		:*If far, submit {{en face}}
	<gallery mode=packed heights=180>		<gallery mode=packed heights=180>
	File:Gross pathology of amputated finger sections in cassette.jpg\|Contiguous longitudinal sections from a finger with suspected osteomyelitis.		File:Gross pathology of amputated finger sections in cassette.jpg\|Contiguous longitudinal sections from a finger with suspected osteomyelitis. {{Moderate-begin}}Here the middle piece can be anatomically oriented by for example the the convexity of the middle phalangeal head, but in cases where it may not be evident, ink one side for orientation.{{Moderate-end}}
	File:Gross pathology of soft tissue margins of an amputated finger.jpg\|Finger with en face soft tissue margins because of no proximity to gangrene.		File:Gross pathology of soft tissue margins of an amputated finger.jpg\|Finger with en face soft tissue margins because of no proximity to gangrene.
	</gallery>		</gallery>

Mikael Häggström: Better

2021-09-17T16:54:58Z

Better

← Older revision		Revision as of 12:54, 17 September 2021
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	*'''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
	:*If far, submit ~~enface~~		:*If far, submit {{en face}}
	<gallery mode=packed heights=180>		<gallery mode=packed heights=180>
	File:Gross pathology of amputated finger sections in cassette.jpg\|Contiguous longitudinal sections from a finger with suspected osteomyelitis.		File:Gross pathology of amputated finger sections in cassette.jpg\|Contiguous longitudinal sections from a finger with suspected osteomyelitis.
	File:Gross pathology of soft tissue margins of an amputated finger.jpg\|Finger with ~~enface~~ soft tissue margins because of no proximity to gangrene.		File:Gross pathology of soft tissue margins of an amputated finger.jpg\|Finger with en face soft tissue margins because of no proximity to gangrene.
	</gallery>		</gallery>

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	#Longitudinal section through distal phalanx		#Longitudinal section through distal phalanx
	#Longitudinal section through proximal phalanx		#Longitudinal section through proximal phalanx
	#Skin and soft tissues at proximal margin, submitted {{en face}}		#Skin and soft tissues at proximal margin, submitted en face
	\|}		\|}

← Older revision		Revision as of 15:10, 23 September 2021
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	*Look at '''soft tissue margins''' whether they look viable or necrotic.		*Look at '''soft tissue margins''' whether they look viable or necrotic.
	*Look at the '''skin surface'''. For any lesion such as ulcerated or necrotic one, measure the distance to the nearest soft tissue margin.		*Look at the '''skin surface'''. For any lesion such as ulcerated or necrotic one, measure the distance to the nearest soft tissue margin.
	*'''[[Inking\|Ink]]''' the surgical margins differently for soft tissue and bony margin{{Moderate-begin}}, including if the bony margin is a joint surface.{{Moderate-end}}		*'''[[Inking\|Ink]]''' the surgical margins differently for soft tissue and bony margin{{Moderate-begin}}, including if the bony margin is a joint surface ("cartilaginous margin").{{Moderate-end}}
	[[File:Gross pathology of amputated finger after longitudinal cutting.jpg\|thumb\|210px\|Amputated finger after longitudinal split.]]		[[File:Gross pathology of amputated finger after longitudinal cutting.jpg\|thumb\|210px\|Amputated finger after longitudinal split.]]
	*'''Split''' the digit longitudinally, either in the midline or at the closest margin between any ulcer and the soft tissue margin.		*'''Split''' the digit longitudinally, either in the midline or at the closest margin between any ulcer and the soft tissue margin.
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	For amputations disarticulated at the '''joint''':		For amputations disarticulated at the '''joint''':
	*Perpendicular sections of articular cartilage and adjacent bone. State which bone in key of sections		*Perpendicular sections of the articular cartilage and adjacent bone. State which bone in key of sections.

	For amputations resected by '''cutting across bone''':		For amputations resected by '''cutting across bone''':
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	'''Gangrene''' and/or suspected '''osteomyelitis''':		'''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~~.		*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/cartilaginous 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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	Example:		Example:
	{\|class=wikitable		{\|class=wikitable
	\| {{Moderate-begin}}A. Labeled - ___. The specimen is received in formalin and consists of an amputated toe/finger.{{Moderate-end}} The digit measures ___ cm in length and ___ cm in average diameter. The digit 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 digit 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.<br>Key to sections:		\| {{Moderate-begin}}A. Labeled - ___. The specimen is received in formalin and consists of an amputated toe/finger.{{Moderate-end}} The digit measures ___ cm in length and ___ cm in average diameter. The digit 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 digit 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 / cartilaginous>> 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.<br>Key to sections:
	#Longitudinal section through distal phalanx		#Longitudinal section through distal phalanx
	#Longitudinal section through proximal phalanx		#Longitudinal section through proximal phalanx, including <<bony surgical / cartilaginous>> margin
	#Skin and soft tissues at proximal margin, submitted en face		#Skin and soft tissues at proximal margin, submitted en face
	\|}		\|}