Which led to you being amputated

Amputation through the ages

The amputation of a limb is one of the most serious interventions in surgery. This has not changed in the past millennia. Progress has improved a lot - also in the field of prosthetics.

Limb amputation is the oldest surgical procedure after skull trepanation and circumcision. Prostheses have been shown to have been used by the ancient Egyptians. The development of medicine has advanced far since the first known amputations.

The stone age of amputation

The first evidence of amputations probably comes from the Mesolithic (8000-6000 BC). Researchers discovered cave paintings depicting amputations of fingers. However, it is not known whether the amputation took place for medical or ritual reasons.

This question can be clearly answered on the basis of a find from ancient Egypt. Professor Doctor Andreas G. Nierlich, Scientist at the Pathological Institute of the Ludwig Maximilian University in Munich 2001 found that severe arteriosclerosis was the reason for amputation of a big toe 3,000 years ago.

During excavations, Nierlich came across the mummy of a fifty to sixty year old Egyptian woman who must have lived between 1065 and 650 BC. In the place of the big toe there is an artistically carved wooden prosthesis, which exactly reproduces the toe including the nail. "The fact that the operation must have already taken place during the woman's lifetime can be seen from the fact that there is an intact layer of connective tissue and skin above the amputation site," explains the pathologist in an article in the Medical Tribune on May 25, 2001.

Traces of use on the wooden toe also suggest the use of the prosthesis. "It can be ruled out that the prosthesis - as was customary back then for life after death - was only added to complete the mummy after death," says Nierlich in the article in the Medical Tribune.

Aulus Cornelius Celsus (25 BC to 50 AD) wrote the first descriptions of the surgical principles of amputation, which are still valid today, in the 1st century AD: “We therefore make a cut with a knife down to the bone between the healthy and the diseased tissue ... whereby it is important to ensure that it is a piece of healthy tissue Tissue is also cut away, so that a piece of diseased tissue remains ... ".

This knowledge from the 1st century BC was lost. Up until the Middle Ages, surgeons severed the limbs where there was no longer any blood circulation in the tissue due to the “burn”. In this way, heavy bleeding could be avoided, but the mostly fatal gangrene could not be controlled. Later, surgeons tried to stop the bleeding mainly with the help of hot iron or caustic drugs. Briefly pressed on the stump, they closed the vessels there.

Progressive pioneering work

middle of 16th century led the French Surgeon Ambroise Paré was the first to perform amputations with arterial ligatures. They replaced the previously common cauterization, the so-called burn-out of the wound. During arterial ligation, arteries and veins were systematically tied with silk thread.

Up until the 19th century, amputations were mainly carried out due to war injuries, epidemics such as leprosy and tuberculosis, frostbite, animal bites and gangrene. Because of the postoperative infections, the death rate was up to forty percent.
Napoleon's chief medical officer, Dominique Jean Larrey (1766-1842) contributed a lot to the further development of amputation technology. He realized that amputation success rates would be greater if he amputated directly on the battlefield, even before the wound had become infected.

Brought to England Robert Liston (1794-1847) the amputation technique far advanced. The sturdy man's knives were designed in such a way that he could cut skin, tendons and muscles down to the bone with a single all-round cut. The skin was cut through with the so-called “tour de main” hand movement, the muscles and the underlying tissue with the “tour de force” force movement. The surgeon took the knife in his hand in such a way that he could suddenly cut around the whole limb.

On December 21, 1846 Liston performed the first amputation with the aid of anesthesia. Until then, a surgeon could only counteract the excruciating pain of cutting and sawing by speeding up the operation.

From the iron to the thinking hand

A good prosthesis was not important until the end of the 19th century due to the high mortality rate. However, the construction of replacement links has been handed down since ancient times.

The iron hand of Götz von Berlichingen (1480 - 1562) is the best known example. In 1504 Götz von Berlichingen had a prosthesis made, which was sensational for the time. The fingers of the prosthesis could be fixed in certain positions by means of toothed wheels. So the Frankish imperial knight could grip his sword firmly and fight with it.

The notorious pirate Barbarossa Horuk had his lost hand replaced by an iron hook prosthesis. Until the beginning of the 19th century, however, these rigid prostheses could only be moved with a healthy hand.

In the year 1812 came the Berliner Dentist and surgical technician Peter Baliff came up with the idea of ​​using the remaining strength of the amputated arm to move the prosthesis. He attached cables around the elbow and shoulder, which allowed the fingers of the prosthesis to be moved. However, the prosthesis wearer had to twist a lot in order to move the artificial hand.

Missing legs were replaced by wooden structures until the 20th century. Thighs were provided with wooden legs that were strapped to the thigh stump. Lower leg amputees bent their stump backwards and kneeled on a stilted leg that was strapped around the lower leg stump.

Development through World War Victims

During the two world wars of the 20th century, many soldiers lost arms and legs. The numerous victims drove the development of the prosthesis.

The German Surgeon Ferdinand Sauerbruch (1875-1951) revolutionized arm prosthetics in 1916. In his Sauerbruch arm, a skin tunnel was placed through the upper arm muscle, through which an ivory pencil was pushed. As the muscle tensed, the pen rose and the hand closed and grabbed.

After the Second World War, electric motors were first used to close the fingers of the hand. Myoelectrical systems have prevailed since the late 1960s. Electrodes on the skin measure the electrical impulses the arm muscle produces when it is tensed. These impulses are passed on to the motors via the electronics and move the fingers.

High-tech prostheses enable today what seemed impossible a few years ago. With the help of a special hand prosthesis it is even possible to feel. In the area of ​​lower limb prosthetics, too, the days of wooden legs are long gone. Precision mechanics has made enormous strides in recent years. Today, researchers in lower limb prosthetics are also working on connecting spare parts directly to the nervous system.

Despite these enormous advances in surgery and prosthetics, amputation was, is and remains traumatic experience. Aids help to replace the function of the lost body part. The future will decide whether they will ever become a fully functional part of the body.

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