Jump To

    Amputations

    Background

    Amputation of limbs, fingers and toes may be necessary due to trauma, ischaemia, infection or presence of invasive malignancies.1-3 However, not all specimens received will require processing of tissue for histological examination.1 Consideration of potential legal implications, religious and cultural practices is particularly important in protocols for retention and disposal of amputation specimens.4

    This protocol is applicable to non-tumour specimens. See protocols for soft tissue tumour or bone tumours where applicable.


    Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

    • No
      • Non-routine fixation (not formalin), describe.
    • Yes
      • Special studies required, describe.
      • Ensure samples are taken prior to fixation.
    • Not performed
    • Performed, describe type and result
      • Frozen section
      • Imprints
      • Other, describe

    See general information for more detail on specimen handling procedures.

    Inspect the specimen and dictate a macroscopic description.


    External Inspection

    Orientate and identify any specific anatomical features of the specimen.

    Record additional orientation or designation provided by operating clinician:

    • Absent
    • Present
      • Method of designation (e.g. suture, incision)
      • Featured denoted

    Photograph the intact specimen if required.

    Describe the following features of the specimen:

    Procedure/specimen type

    Record as stated by the clinician.

    • Disarticulation (cartilage-covered joint), describe
    • Amputation (exposed bone), describe
    • Other, describe

    Specimen laterality

    • Left
    • Right

    Specimen integrity

    • Intact
    • Disrupted/fragmented/opened, describe

    Anatomical components included (more than one may apply) and specimen dimensions (mm)

    Describe and measure the anatomical components present.

    • Total size in three dimensions
    • Specimen weight (g)
    • Size of each component structure in three dimensions
    • Abnormality in three dimensions

    Evidence of previous biopsy or surgery (if present)

    • Needle track
    • Scar
    • Sutures

    Soft tissue at resection margin

    • Condition, describe

    Skin

    • Normal
    • Abnormal, describe, for each location record location, structures involved, thickness and dimensions (mm)
      • Ulceration
      • Discoloration
      • Swelling
      • Gangrene
      • Trauma/tissue disruption
      • Tumour (for description, see skin protocol)
      • Other, describe

    Dissection

    Amputation of digit(s):

    Fingers and toes are usually removed because of vascular insufficiency, tumour or trauma. A sagittal section from the surgical margin and representative sagittal sections through any ulceration or tumour including any underlying bone(s) and soft tissue should be undertaken. A period of fixation and decalcification after sectioning should be undertaken (see decal)

    Limb amputation:

    For vascular insufficiency or non-neoplastic ulceration.

    In many cases an extensive anatomical dissection will not be required.

    However, if a comprehensive vascular assessment is requested the following dissection should be considered.

    Open the specimen with an incision through the skin behind the medial malleolus, cutting obliquely towards the posterior leg then the full length of the leg superiorly to the resection margin. Extend the incision distally, opening the skin on the dorsal surface of the foot just distal to the ankle.

    Locate the posterior and anterior tibial neurovascular bundles; expose by removing the surrounding muscle and soft tissue. Sever from the specimen and remove the blood vessels and allow to fix overnight.

    Serial sectioning of arteries should be undertaken to accurately document any pathological changes such as atheroma and/or thrombosis.

    Sagittal sections through areas of ulceration should be undertaken followed by appropriate periods of fixation and decalcification (see fixation and decalcification).

    See also protocols for femoral head, bone tumours and soft tissue tumours.


    Internal Inspection

    Describe the internal or cut surface appearance including the following items:

    Tumour (if applicable)

    Blood vessels

    • Normal
    • Abnormal, record name of the vessels, describe the location and extent of pathology
      • Occlusion (%)
      • Atheroma
      • Thrombosis
      • Other, describe

    Ulceration

    • If present, record
    • Depth of involvement (mm)
    • Tissues and bones involved

    Photograph the dissected specimen.

    Note photographs taken, diagrams recorded and markings used for identification


    Processing

    Dissect the specimen further and submit sections for processing according to the diagram provided.

    Submit representative sections of:

    • Surgical margins; bone, soft tissue and skin as required
    • Lesion demonstrating relationship with adjacent skin and/or soft tissue
    • Sagittal section through any ulcer to underlying bone and/or joint, if applicable
    • Blood vessels, transverse sections of any significant pathology

    Record details of each cassette.

    An illustrated block key similar to the one provided may be useful.

    Block allocation key

    Cassette id
    Site
    No. of pieces
    A-B
    Surgical margins
     
    C-D
    Tumour or lesion demonstrating relationship with adjacent tissue
     
    E
    Sagittal section through ulcer demonstrating underlying bone/joint if appliable
     
    F-G
    Blood vessels, representative sections
     

    References

    1. Lester SC (ed). Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010.
    2. Athanasou NA and Mangham DC. Dataset for histopathology reports on primary bone tumours, The Royal College of Pathologists, London, 2010.
    3. Freemont AJ, Denton J and Mangham DC. Tissue pathways for bone and soft tissue pathology, The Royal College of Pathologists, London, 2011.
    4. National Pathology Accreditation Advisory Council (NPAAC)(2009).Requirements for the Retention of Laboratory Records and Diagnostic Material, Australian Government, Department of Health and Ageing, Canberra.

    Jump To

      Page last updated:

      Copyright © 2019 RCPA. All rights reserved.

      27-Mar-2019
      Top