Hallmarks of amputation surgery.

Abstract

To highlight the most important innovations and milestones in the historical evolution of amputation and disarticulation surgery through the ages, from the early antiquity until the modern era. A thorough search of the literature was undertaken in PubMed and Google Scholar as well as in physical books in libraries to summarize current and classic literature on the hallmarks of the history of amputation surgery in the course of medical history. Amputation of a limb is one of the oldest surgical procedures. Initially, it was fraught with complications and dismal outcome of the patients because of hemorrhage and infection. Due to lack of analgesics and narcotics the operation had to take only a few minutes. Obtaining experience, the surgeons evolved the operative technique and refined the procedure, anesthesia and perioperative analgesia was introduced, instruments were developed, and rehabilitation has enabled functional and social reintegration of amputees. From the Hippocratic era until currently, the surgical approach to amputation has changed little. However, the indications for amputations have changed a lot and had been refined, especially in diabetic patients and in those with severe chronic peripheral vascular disease. An exponential decrease in mortality for an operation once fraught with complications was due to the development of the tourniquet, proper vessel ligation and repair, antisepsis, and anesthesia.