Investigations

Open Muscle Biopsy

Purpose

To obtain muscle tissue specimen for diagnostic study.

Preparation

No fasting or other special preparation is usually necessary. You may be asked to wear loose clothing or a hospital gown so that the muscle chosen for biopsy is easily accessible. A nurse will bring you into the theatre and the following procedure will be explained. The doctor will outline the risks of the procedure and answer any questions that you may have. You will then be asked to sign the consent form.

Procedure

You will be asked to lie on your back on the operating table for the duration of the procedure which lasts approximately 15 minutes. The sample may be taken from the leg or arm and the exact muscle chosen may have been discussed with your doctor already. If not, the surgeon will inform you of the muscle being sampled. The area is cleansed with antiseptic and then covered with a sterile drape. Local anaesthetic (lignocaine and adrenaline) is then injected. This may produce a temporary stinging sensation before the area becomes numb. Five minutes is allowed for the skin area to become numb. The surgeon will then make an incision through which he can identify and remove the muscle specimen. You may experience some pain, but this is unavoidable as any local anaesthetic injected into the muscle causes damage that prevents diagnostic analysis. After an adequate specimen is obtained the incision is closed.

Possible complications

The risks are minimal but and may include the following:

  • Infection (a slight risk any time the skin is broken)
  • Bleeding of the site
  • Bruising of the area
  • Damage to the muscle tissue or other tissues in the area (very rare)

Rarely, it may not be possible to get an adequate sample of muscle despite our best efforts.

Post-procedure care

The surgeon will probably use dissolving sutures, which do not require removal. Ask the nurses on the Day Surgery Unit about this. If small knots remain at each end of the incision, these can be clipped off with cuticle scissors two weeks after the surgery.

The area of the surgical incision will be covered with a dressing. The area should remain covered with a sterile dressing for ten days. The nurse on the Day Surgery Unit will advise you further about this. KEEP THE BIOPSY SITE DRY UNTIL THE DRESSING IS REMOVED. When showering, tape a piece of plastic around the region. This is to prevent infection in the open wound.

You can walk around (for a thigh biopsy), or use your arm (for an arm biopsy), but avoid strenuous activity for the next 7 days.

The site of the biopsy may ache for up to one week once the local anaesthetic has worn off. It may feel like you have bumped into the edge of a table. You can take ibuprofen or paracetamol for the pain but please do not take high dose aspirin as this thins the blood and may cause bleeding. (If you are on low dose aspirin anyway then please continue to take it).

It is all right if there is small amount of blood at the site. However, if there is a lot of bleeding, swelling, redness or other complications, please call the Day surgery unit.

If you have problems after the procedure contact;

If you have any problems, or you need to call for advice, please telephone the surgery centre where you had the biopsy. You should be given their direct phone number for both office hours and out of office hours before you leave the centre.

If these measures fail, please contact your GP or nearest A&E department.

If you have questions after the procedure contact;

Dr Rose's secretary; 020 3299 8343

Muscle Biopsy: Storage, analysis and results

What happens to the muscle samples?

The muscle samples are specially frozen so that they can be properly analysed. The frozen muscle samples are sliced into very thin sections, mounted on glass slides and treated with special stains that allow us to visualise various aspects of the muscle structure (histological stains). Other staining techniques allow us to visualise some of the biochemical functions of the muscle (histocytochemistry). Sometimes electronmicroscopy is used to allow us to see muscle structure at very high magnification. These test are done to diagnose your muscle condition.

Many of the analytical techniques are performed in the pathology laboratories at King's College Hospital. Occasionally it is helpful to send some of the muscle sample to other laboratories in this country, or abroad for more specialist biochemical analysis in order to diagnose your muscle condition. We need your permission to send muscle samples to other laboratories for this biochemical analysis.

As well as analysing the structure and biochemistry of the muscle samples we can also perform genetic tests on the muscle samples in order to help diagnose your muscle condition. Genetic studies are done in various laboratories in this country and abroad. Again, we need your permission to send muscle samples to other laboratories for this genetic testing.

Freezing your muscle biopsy samples also allows us to store the samples for future analysis. If no relevant biochemical or genetic test is currently available to diagnose your condition, the sample will be stored until such time that an appropriate test is developed.

It may be very helpful to use your stored muscle sample anonymously for research purposes. Such research may include the development and standardisation of new tests or basic science research to better understand muscle diseases. You may not personally benefit from such research but it may benefit others with muscle disease.

It may also be helpful to use, anonymously, pictures of your muscle slides for educational purposes such as lectures and teaching sessions to medical audiences. We need your permission before we can use any of your stored muscle samples for such educational purposes.

When do I get my results?

The basic histochemical and histocytochemical stains are ready to analyse within one week of the biopsy. I attend the meeting with the muscle pathologists at which we look at muscle biopsy results, discuss the findings and agree the diagnosis or other tests needed to make the diagnosis. The formal agreed report on the biopsy is then available 2 weeks after the biopsy. You should check with my secretary that the report is available before arranging an appointment to discuss the biopsy results after 2 weeks. If more detailed studies are required these may take several weeks to complete and then a supplementary report will be issued.

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