This video details the gross examination and sectioning of a left transmetatarsal foot amputation specimen. The primary clinical focus is confirming or ruling out osteomyelitis (bone infection), necessitating precise sampling of targeted bones (specific phalanges and metatarsals) as guided by pre-operative MRI imaging. The prosector identifies and measures two distinct surface lesions—a dorsal ulceration that reveals a sinus tract upon sectioning, and a fibrous plantar excrescence. The video emphasizes the critical importance of correlating gross examination with detailed clinical history to ensure all suspicious areas and surgical margins (skin/soft tissue and bone) are appropriately sampled, employing specialized snips for efficient bone removal.
Gross Examination of a Transmetatarsal Amputation for Osteomyelitis
0:13 Specimen Identification: The specimen is a left transmetatarsal amputated portion of the foot, disarticulated at the metatarsophalangeal joints.
0:25 Clinical Context (Osteomyelitis): The key clinical concern is osteomyelitis (bone infection). It is crucial to check the clinical history and MRI/imaging to determine which specific bones are suspected of infection and require targeted sectioning.
1:13 Dimensions: The specimen measures 11.3 cm in width, 13.0 cm in length, and 3.5 cm in height.
1:50 Dorsal Lesion: An ulceration (0.8 x 0.6 cm, tan-red) is noted in the second metatarsal region, 0.2 cm from the margin.
2:04 Plantar Lesion: A white, raised excrescence (2.0 x 0.8 cm) is noted on the plantar surface, 0.9 cm from the margin.
3:40 Internal Findings: Sectioning the dorsal ulceration reveals a tan-red sinus tract extending into the subcutaneous tissue, often indicative of an underlying abscess or communication with an infected source.
4:09 Targeted Bone Sampling: Clinical suspicion (from MRI) targets the second metatarsal bone and the second, third (middle), and fourth (proximal) phalanges for osteomyelitis confirmation.
5:51 Bone Sampling Technique: Specialized snips are used to cut and sample the small bones, as this is faster and easier than using a hammer and knife for multiple samples.
6:55 Key Takeaway (Clinical Correlation): The prosector stresses the importance of following the clinical suspicion explicitly, ensuring all bones flagged in the patient's MRI/history are sectioned to prevent the pathologist from requesting additional sections later.
8:02 Suspicious Bone: The second metatarsal bone cuts very easily, raising suspicion of severe involvement by osteomyelitis compared to other, firmer bones.
10:59 Section Summary: The final submission includes: dorsal and plantar soft tissue margins, sections of both skin lesions (ulceration/sinus tract and excrescence), sections of the four clinically suspected bones, and the metatarsal bone resection margins (second, third, and fourth).