This video provides an instructional gross dictation of a surgically amputated left great toe specimen, featuring complex pathological processes including cellulitis, gangrene, and abscess formation. The pathologist guides residents through the proper descriptive language, emphasizing precise anatomical terminology (such as "disarticulated" versus "transected") and required measurements. The dictation details the extensive gangrenous change approaching the skin margins and involvement extending to the underlying bone. A critical instructional point is made regarding the mandatory submission of bone at the resection margin whenever sections of infected bone are taken, preparing the specimen for appropriate decalcification and microscopic examination.
Dictating a Left Great Toe Amputation: Gross Examination for Residents
0:11 Introduction: The video aims to dictate the gross pathology of a complicated surgical specimen (cellulitis, gangrene, abscess in a toe) to instruct pathology residents on proper procedure and terminology.
0:45 Specimen Description: The specimen is labeled "left great toe" and consists of a 6.3 cm x 3.4 cm amputated digit.
1:03 Requisite Terminology: The digit is disarticulated at the metatarsal phalangeal joint. The pathologist stresses using "disarticulated" when the margin is an articular surface, rather than "transected."
1:33 Anatomy Lesson: The speaker provides a quick review of toe/finger anatomy, noting that all digits except the great toe and thumb have two phalangeal joints (proximal and distal).
2:19 Gross Pathology β Gangrene: The gangrenous process is extensive, occupying approximately 80% of the digit (3.2 x 3.0 cm), involving the entire nail bed, and grossly approaching the skin and soft tissue resection margin.
4:18 Sectioning Findings: Sectioning through the gangrene reveals tan-brown to red edematous subcutaneous soft tissue extending to the underlying bone. The bone beneath the gangrene is described as firm, an important detail for assessing potential osteomyelitis.
5:06 Critical Takeaway (Bone Margin): The pathologist advises that if sections of infected bone are submitted, the bone at the resection margin must always also be submitted for light decalcification and examination.
6:19 Cassette Dictation: The final submitted sections include: (1) Skin and soft tissue resection margin on frozen section ('F.S.'), (2) Gangrenous skin with underlying soft tissue and bone (following light decalcification), and (3) Bone at the resection margin (following decalcification).