• Determine the reason for the amputation (e.g. gangrene, trauma, infection), the level of amputation (e.g. transmetatarsal/ transmetacarpal, below knee/elbow, above knee/elbow), and the parts of the extremity present (e.g. digits with/without nails, foot/hand, distal leg/arm, knee/elbow, proximal leg/arm).  Measure the lengths of each part.  Measure the greatest circumferences of the lower leg/arm and upper leg/arm.
• Examine the resection margins of skin, soft tissue and bone for necrosis or other abnormalities.  Check the vascular resection margins for occlusion.  If a traumatic amputation, note whether the amputation site is smooth and even or jagged and irregular.
• Open the knee joint and determine whether it is artificial (prosthetic).   Describe the joint fluid.
• Identify lesions (e.g. scar of prior surgery, ulcer, hard and black toe, laceration, necrosis) and the extent (e.g. involving underlying bone).  Measure discrete lesions and dictate where each is located.  Note the presence of foreign material (e.g. glass shards, motor oil, dirt) in traumatic amputations.
• For non-traumatic legs:  Dissect the neurovascular bundles of femoral, popliteal, tibial, and peroneal vessels, so as to expose them along their entire course.  Inspect vessels for atheromatous plaque, calcification, and thrombus, and estimate the degree of luminal stenosis as a percentage.  Identify and examine the dorsalis pedis vessels by cross-sectioning the dorsal surface of the foot.
• If vascular graft or stent is identified, dissect en block and photograph.

• Gangrene and infection:

• Representative skin and soft tissues from areas of ulceration, necrosis, infection, and other abnormalities.
• Cross sections of major arteries and veins from segments with greatest stenosis:  1 block for each.  You may submit heavily calcified arteries for light decalcification.
• Skin, soft tissue, and vascular margins of amputation:  1 section of anterior and 1 section of posterior.
• Bone and joint if clinical suspicion of osteomyelitis (you may need to check x-rays or radiology reports to determine exact location) or if grossly involved by necrosis/infection.
• Traumatic amputation:
• Skin and soft tissues from areas of laceration and hemorrhage.
• Skin and soft tissue margins of amputation.
• Any other abnormalities.

Internal use only

Received wrapped in a biohazard bag without fixative/in formalin, labeled _____ and “_____” is a _____ (e.g. below knee) amputation of the _____ (left or right) _____ (e.g. leg).  It measures __ cm from distal toe tip to heel, __ cm from heel to knee joint, and __ cm from knee joint to soft tissue margin.  __ cm of _____ (e.g. femoral) bone extends beyond the soft tissue margin.  The skin, soft tissue, and bone at the margin appear viable.  The _____ (e.g. femoral) artery at the margin is approximately __% stenosed by yellow plaque.  The knee joint is native/artificial and contains clear fluid.  There are __ (number) toes/fingers, all with intact _____ (e.g. thickened, yellow) nails/except for the _____ (e.g. third toe), which is missing its nail.  The _____ (e.g. fifth) toe is black, hard, and dry.  There is a __ x __ cm ulcer in the skin of the _____ (location) which does not/does extend to bone which is soft and easy to cut.  The skin over the _____ (location) is _____ (e.g. hairless) and has _____ (e.g. numerous pinpoint areas of hypopigmentation, a __ cm healed linear scar).  The subcutaneous tissue/muscle of the _____ (location) is _____ (e.g. edematous, diffusely necrotic).  The _____ artery is __- __% stenosed by calcified yellow plaque throughout its length but most significantly at its _____ (e.g. upper third).  [Repeat for all arteries].  No venous thrombi are identified.  Representatively submitted as follows:

#__ = skin and soft tissue at anterior resection margin, 1 piece

#__ = skin and soft tissue at posterior resection margin, 1 piece

#__ = ulcer, 2 pieces

#__ = skin with scar, 1 piece

#__ = femoral vessels, 4 pieces (the proximal section inked black)

#__ = popliteal vessels, 4 pieces (the proximal section inked black)

#__ = anterior tibial vessels, 3 pieces (the proximal section inked black)

#__ = posterior tibial vessels, 3 pieces (the proximal section inked black)

#__ = peroneal vessels, 3 pieces (the proximal section inked black)

#__ = dorsalis pedis vessels, 2 pieces (the proximal section inked black)

#__ = bone under ulcer, for decal, 1 piece

__ blocks, __ H&E, __ decal