Amputation

Amputation is the surgical removal of all or part of an appendage (such as a leg or arm). Amputation has been practiced since earliest times, but usually out of desperation, as in the case of a crushed limb. Early attempts at amputation were often unsuccessful because the patient was likely to die from bleeding or infection during or soon after the procedure was performed.

From the time of ancient Greek physician Hippocrates (460-370 B.C. ) until the 1500s, amputations usually involved cutting through dead rather than living tissue because dead tissue did not hemorrhage (bleed uncontrollably). Stumps, or the remaining limb tissues, were then sealed with red-hot irons or boiling oil or tar. This burning procedure stopped most bleeding and was also thought to help prevent gangrene (tissue rotting). In the mid-1500s, German surgeon Fabricius Hildanus (1560-1634) began using a red-hot knife for amputations, which both removed the limb and controlled bleeding at the same time.

Paré's Discovery

The postamputation sealing process was called cauterization. Cauterization was terribly painful for patients, who usually did not have any anesthesia during the procedure. French surgeon Ambroise Paré (1510-1590) helped change this painful fact in the 1500s. By Pare's time, gun-powder had made battlefield injuries so horrible that amputation became commonplace. Even amputation at the thigh, which previously had been very rare because of the extremely heavy (usually fatal) bleeding, was now often necessary. Pare's great improvement was ligature (tying off of the blood vessels rather than cauterizing them). Earlier surgeons had proposed ligature, but it was Pare who developed a successful technique to carry it

Scientific advances in the development of prosthetic devices have given amputees greater mobility.

Petit Designs the Tourniquet

Although Paré's method was more effective than cauterization, it did not always work because of the large number of blood vessels involved in major amputations. A way was needed to control bleeding until the surgeon could tie off all the vessels. This control was finally provided by the effective tourniquet (pronounced "turn-i-ket") designed by J. L. Petit (1647-1750) in 1718. Petit's screw tourniquet was fixed to the lower abdomen and put direct pressure on the main artery.

With bleeding controlled by Petit's tourniquet, Paré's ligatures were now practical. Amputations on the battlefield were carried out swiftly and in great number. One French surgeon performed 200 amputations in a single day during the Battle of Borodino (Russia) in 1812. Unfortunately, while patients no longer died routinely of bleeding during an amputation, many died of infections afterward. It remained for Joseph Lister (1811-1886) to introduce antiseptics for amputation to become a successful procedure. As modern physicians learned new, effective ways to treat illnesses and infections, amputation steadily became less necessary.

Today, the majority of patients who undergo amputations do so for medical reasons (such as diabetic complications). With the problems of bleeding, anesthesia, and infections solved, the emphasis is on construction of effective prosthetics ( artificial limbs ) and physical therapy that allow patients to return to a fairly normal life.