Subjects

Amputation: history, causes, process


Slimming limbs
Amputation means artificially separating a part of the body from the body, usually surgically, to save a person's life, or when the separated part cannot heal, or as a punishment.

Origins in the Stone Age

Amputations are among the earliest medical measures we know, and people from the Stone Age already separated body parts - 10,000 years ago.

In the high cultures of the Middle East and the Old Testament, the chopping off of the hand was the punishment for theft, which proves that amputations were also widespread here.

Cornelius Celsus (50 BC to AD 50) discussed cutting away as a medical method: “We therefore use a knife to make a cut down to the bone between healthy and diseased tissue (...) taking care that a piece of healthy tissue is cut away rather than a piece of sick tissue remaining. "

The Greco-Roman doctors knew different treatments to heal the amputation wound. The surgeon Archigenes thought it right to tie off the limb before the amputation and then to burn it out with a branding iron.

The scholars fought over whether only the sick or the healthy part of the limb should be severed. In practice, however, the Romans almost exclusively amputated the diseased section, and this probably led to the wound becoming infected.

In addition, the ancient peoples already used prostheses. The shard of a vase from Italy of the 4th century BC shows A person with an amputated lower leg who wears a wooden prosthesis, and Herodotus wrote about a wooden base a century earlier. Pliny then reports in the 3rd Chr. Of a soldier who carried an iron hand.

Firearms and lethal inflammation

In the Middle Ages there were ample reasons to amputate parts of the body. Parts of the leprosy rotted with alive body, dog bites caught fire, gangrene was omnipresent in the wars.

The doctors in Germany did not know the discussion of antiquity until the early modern period and only cut away the burnt tissue. The only instruments used were knives, amputation saws, pliers and chisels. No one knew about the danger from viruses or bacteria, and the tools contaminated with germs drove the patients even more towards the exitus. The doctors closed the wound with a branding iron. The heat closed the vessels, but could cause new injuries and inflammation.

The executioners became specialists in amputations and their treatment. Executioners were not only tasked with punishment such as knocking off their hands. Such mutilations, which seem barbaric today, were not arbitrary, but a crime was regarded as a disruption to the order God wanted: the punishment did not apply to the individual, but was intended to restore the divine order.

Therefore, the executioner had to execute the punishment according to a precisely defined ritual. If he amputated a limb, the wound became inflamed and the delinquent died, the executioner had committed a crime that he could hardly make up for.

Executioners were also the only ones who knew about human anatomy. Scholarly doctors were prohibited from dissecting corpses and were considered blasphemy. However, the executioners cut up corpses and sold the “magic medicine” they gained, and when they put on thumbscrews, dislocated bones, or put weights on their chest, they had to know exactly how this torture affected the body.

The invention of firearms greatly increased the need for amputations. Hans von Gersdorff wrote in 1517 how the amputations of the early modern period went. Those affected sat down and were given only opium and henbane for anesthesia. When the limb was severed, the doctor pulled a cow or pig's bladder over the stump.

Except in the case of war injuries, the doctors usually only amputated when the gangrene had already broken out or the wound had become infected. Most people who underwent amputation died during or after the operation, from blood loss or the sore wound.

Only the surgeon Ambroise Paré prevented bleeding by blocking the blood vessels with triangular needles. The Swiss doctor Fabricius Hildanus also correctly called for amputation in healthy tissue and sealing the stump with linen. The Englishman Lowdham used a meat cloth instead of cloth.

In 1504, Götz von Berlichingen (1480 - 1562) not only survived the loss of his hand, but he also had a refined prosthesis made of iron. Their fingers fixed cogwheels. The robber knight could even adjust the iron hand to grab his sword.

Modern war surgery

The guillotine replaced the medieval mutilation and death penalty such as wheels, four-parts or hands in the French Revolution. While amputations no longer played a role as punishment in Europe, it became one of the most important medical practices in modern material warfare.

Cannons and shrapnel bullets shredded their bodies, their arms and legs, hands, feet and faces, completely or half severed, were the gruesome face of modern times, in which crowds marched against crowds.

So it was no accident that the doctors on the battlefield developed the amputation further. The chief medical officer of Napoleon, Dominique Jean Larrey (1766-1842), was decisive. He operated directly on site before the infection started.

Robert Liston (1794-1847) developed knives that cut skin, tendons and muscles to the bone with one cut, and the surgeon cut all around the limb. Liston also used anesthesia instead of speed.

The development of prostheses made great progress in the two world wars. Ferdinand Sauerbruch (1875-1951) put a skin tunnel through the upper arm and pushed an ivory pen through it. This rose when the muscle tensed and the hand reached out.

Since the 1960s, electrodes have been measuring electrical impulses in the arm muscle and transmitting them to motors that move the fingers. Today you can even feel it with hand prostheses.

With leg prostheses, it is sometimes possible to couple the artificial parts to the nerves.

What amputations are there?

Today, the main causes of amputations are circulatory disorders, injuries and infections - especially arteriosclerosis. The lower part of the legs is most at risk.

We refer to an amputation above the ankle as a major amputation. Legally, however, a forefoot amputation is already considered as such.

Minor amputations are amputations below the ankle, especially on the toes.

Scheduled amputations usually occur because of arterial occlusive disease when tissue necrosis heralds sepsis and all other methods fail. Where amputation is done depends on the quality of the blood flow in the respective body parts. The thigh is usually amputated a hand's breadth above the knee, the lower leg a hand's breadth below.

Today, doctors very rarely amputate in accidents. The goal is always to preserve the limbs, and the current state of the art makes it possible to re-implant even severed parts of limbs. However, if the corresponding part of the body is destroyed, the doctors can only treat the stump.

Uncontrolled infections of wounds and open grade IV fractures make amputation inevitable.

Even malignant tumors sometimes still require limb amputation, usually for bone or soft tissue cancer.

How does an amputation work?

A scheduled amputation is primarily designed in such a way that the stump is easy to care for. The bone must be covered with soft tissue and the skin incision lies below the amputation on the bone - doctors speak of frog mouth incision. If the bone is severed, the surgeon smoothes the bone edges. The muscles then surround the bone stump, and the medic connects the muscles.

After that, it's about avoiding infection. Occlusive disease and diabetes, the two main reasons for amputations, often cause problems with wound healing.

The doctor fixes the stump with a special bandage. When the wound heals, the doctor puts on an elastic cover, and later he uses this to attach the prosthesis socket.

The Krukenberg gripping pliers use spoke and ell to grasp. In the case of amputations on the forearm, these bones “replace” the hand in a makeshift manner.

Special amputations

During the Pirogoff amputation, the foot is amputated, but the heel bone and parts of the foot Google are retained.

The Gritti-Stokes amputation is an amputation on the thigh in the immediate vicinity of the knee joint. The patella remains in place, the surgeon presses it under the stump, fixes it there and sews the patella tendon to the knee flexor tendons. This makes the stump long and elastic.

Emergency amputations

Emergency doctors sometimes have to amputate directly at the scene of the accident, especially in the event of spills if there is no technical rescue in sight, the affected limbs have been pinched and are in mortal danger.

The emergency doctor ensures that the vital functions are retained, for example, lays the person on their side, ventilates or resuscitates them if the situation so requires.

He carefully stores the separated body part in aseptic material. If possible, the amputate is transported cool to keep it in the shape it was in the accident. It comes in a plastic bag, and this comes in another bag that contains ice. However, the ice must not come into contact with the tissue to avoid frostbite.

Amputation as a punishment

Today, limbs are cut away as punishment only under Islamic rule. According to Surah 5:38 of the Koran, thieves' hands are to be cut crosswise, according to Sura 5:33 for street robbery and the fight against the messengers of God. Judges rarely imposed both punishments in historical Islam, and at the turn of the 20th century almost all states abolished these punishments.

The amputations remained uninterruptedly only in Saudi Arabia under the rule of the Wahhabis. The triumphal march of the Islamists since 1972 brought the cutting off of hands and feet back to prison in Libya, Pakistan, Iran, Sudan and parts of Nigeria; in Sudan there were 120 amputations between 1983 and 1985 alone. The practice continues to this day. (Dr. Utz Anhalt)

Author and source information


Video: WexMed Live: New surgeries to reduce amputees pain (December 2021).