Amputation through the Ages: A Time-Honored Way to Save Lives
In 1517, Hans von Gersdorff published his Field-Book of Wound Surgery. He advocated similar techniques used in ancient times, which were far more humane than those used by the barber surgeons. A French surgeon, Ambroise Paré, was inspired by von Gersdorff, and Paré used the ancient technique of ligature rather than painful cauterization to prevent hemorrhaging. Paré also invented an instrument he called the “crow’s beak,” which today we know as a hemostat. Paré’s goal was survival of his patient but also the formation of a stump that could support a prosthetic device. An effective screw tourniquet was designed by J.L. Petit, which greatly enhanced Paré’s ligature technique. With those techniques, battlefield amputations could be performed more quickly; surgeons relied on speed and technique to improve survival rates and minimize pain.
During the Napoleonic wars, field soldiers were considered dispensable and the wounded were often left on the battlefield to die. A former navy doctor, Dominique Jean Larrey, was assigned as a Surgeon-Major in the Army of the Rhine. Because of his compassion for the common soldier, he advocated timely medical care on the battlefield. The idea of triage (prioritization of patients for medical treatment) came from Larrey’s care of wounded soldiers.
In 1846, ether was first used as an anesthetic at Massachusetts General Hospital. Joseph Lister (1811-1886) used carbolic acid as an antiseptic in 1867. Both of these innovations greatly increased the success of amputations, although Lister’s aseptic technique was slow to catch on. Unfortunately, the doctors tending the wounded on Civil War battlefields did not understand the need for cleanliness. They had no concept of sterilization or germs. Bones were shattered by the large-caliber bullets of the day, ripping and infecting the flesh beyond repair. Wounds, even small ones, would become infected, then gangrenous, and then the only way to save a soldier's life before the infection took over his body was to cut off the limb. World War I brought trench warfare, and many soldiers lost their feet due to “trench foot” (prolonged exposure to damp, cold, unsanitary conditions).
When foot amputation is necessary, the ideal operation would be one that creates a weight-bearing stump. A useful method of foot amputation was first advocated by Sir James Syme of Edinburg, Scotland. He developed his procedure in 1843, and the weight-bearing surface it provided proved invaluable to the amputee. Syme’s amputation involves removal of the foot through the ankle joint, which also removes the malleoli (the two rounded protrusions on either side of the ankle). The heel pad is sewn over the end of the remaining tibia (lower shin bone). A Syme’s amputee is actually able to walk on the stump without a prosthetic.
Amputation surgery continued to improve through World War II, the Korean War, and the recent wars in Iraq and Afghanistan. The great innovations have been the tourniquet, ligation, aseptic conditions and anesthesia.
Today, type 2 diabetes is the number one cause of amputation in the United States. Among diabetics who have a lower extremity amputation, up to 55% will lose the second limb within 2-3 years. The importance of taking care of the diabetic foot cannot be stressed enough (See Daily Foot Care for People with Diabetes).
Escape from a Greater Affliction: The Historical Evolution of Amputation: http://www.dmu.edu/wp-content/uploads/2011/06/Howard-A-Graney-Submission-M-Wooster.pdf
Medical Discoveries: Amputation: http://www.discoveriesinmedicine.com/A-An/Amputation.html
Minor foot wounds - a major threat for diabetics: http://www.reuters.com/article/2014/04/14/us-foot-diabetics-idUSBREA3D0UJ20140414
Modified Syme Amputation: http://www.acpoc.org/library/1965_04_006.asp
Video clip from the director’s cut of Dances with Wolves: http://www.bing.com/videos/search?q=dont+take+my+foot+dances+with+wolves+video&FORM=VIRE2#view=detail&mid=71B523128C1156B68E8971B523128C1156B68E89
- Patty Boyd, IPFH
Reviewed by: Rachel Rader, DPM, IPFH Scientific Advisory Board
Last updated: April 27, 2016
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