This video provides a practical, fast-paced tutorial for pathology residents on dictating the gross examination of a surgical amputation specimen: the left great toe, removed due to cellulitis, gangrene, and an abscess. The demonstration emphasizes precise anatomical terminology, such as using "disarticulated" at the metatarsal phalangeal joint rather than "transected." The gross findings include extensive gangrene occupying approximately 80% of the digit and involvement of the underlying bone, which is assessed for firmness (relevant to potential osteomyelitis). The dictation concludes with the specific instructions for submitting sections, focusing on the critical skin/soft tissue margin closest to the necrosis and separate sections of the bone margin requiring decalcification.
Gross Examination Dictation: Left Great Toe Amputation
0:11 Dictation Tutorial Purpose: The speaker begins a fast-paced dictation and demonstration aimed at helping pathology residents properly gross and dictate findings for specimens involving cellulitis, gangrene, and abscess in a toe.
0:45 Specimen Description: The specimen is quoted as the "Left great toe," measuring 6.3 cm in length by 3.4 cm in diameter.
1:03 Margin Terminology (Anatomy Lesson): The digit is described as disarticulated at the metatarsal phalangeal joint (MTP joint). The speaker emphasizes using "disarticulated" when an articular surface is present at the resection margin, rather than the less specific term "transected."
2:19 Gross Pathology Extent: The gangrenous process grossly approaches the skin and soft tissue resection margin, occupying approximately 80% of the digit (3.2 x 3.0 cm), including the entire nail bed.
3:25 Sectioning Findings: Sectioning reveals tan-brown to red, edematous subcutaneous soft tissue extending down to the underlying bone.
4:33 Bone Assessment Tip: The speaker notes that the bone underlying the gangrene is "firm," a key detail that should be included in the dictation to aid in the histological diagnosis of potential osteomyelitis.
5:06 Rule for Bone Submission: A crucial procedural rule is highlighted: If sections of infected bone are submitted, the bone at the resection margin must also be submitted.
6:19 Final Submission Log (3 Sections): Representative sections are submitted as follows:
Skin and soft tissue resection margin (closest to the gangrene).
Gangrenous skin with underlying soft tissue and bone (requires light decalcification).
Bone at the resection margin (requires decalcification).