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The evolution of lower limb amputation through the ages. Historical note

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Abstract

The aim of this study was to highlight the important stages of the evolution of limb amputation through the ages through the search of the relevant international literature. Limb amputation is one of the most serious surgical operations, which is associated with high mortality and morbidity. Evidence regarding the execution of limb amputation can be found back in Neolithic times. The most important steps in the evolution of the technique of limb amputation were made in the 16th, 17th, and 18th centuries when A. Pare' introduced the vessel ligation and the French barber surgeon Morell introduced the use of a tourniquet to reduce the bleeding. During the same period, from the ''one-stage circular cut'' the technique evolved to either ''three-stage circular cut'' or to ''flap amputation'', single or double. Limb amputation represents one of the oldest and most serious surgical operations. Its evolution parallels the maturation process of surgery, with the major developments in the technique to have been made from the 16th to the 18th century. In the beginning of the 21st century, limb amputation appears to be a safe operation ending up with a functional stump.

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... Despite major medical advances specific to those injured on the battlefield, major limb amputation surgery has not undergone significant procedural changes since the time of the Civil War. 1,2 The subsequent development of prosthetic limb replacements have been driven in most part, by the dissatisfaction of veterans with an amputation to return to pre-injury function. ...
... 24 Our ultimate goal is to develop a robust, functional unit for prosthesis control in humans; an osseointegrated neural interface (ONI), consisting of (1) nerves transposed into bone, (2) creation of a neural interface within the medullary canal of long bones, and (3) an osseointegrated prosthetic abutment for improved stability, connectivity, and functionality. Each of the three components of the ONI have the potential to independently improve quality of life for the amputee through (1) resolution of neuropathic/phantom pain, 16 (2) control of an advanced prosthesis, and (3) improvement of naturalistic motion and load bearing, respectively. Combining these three complementary technologies into one paradigmshifting technology has the potential to substantially improve the utilization of prostheses through improved functionality to better serve both veteran and civilian amputees. ...
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... He was particularly concerned with the treatment of vertebral deformities and especially scoliosis, for which he imagined new innovative therapeutic procedures. He also contributed to improve the technique of surgical amputations and to development of limb prostheses [4,6,7,13,15,17]. ...
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Ambroise Paré was a renowned French barber-surgeon, considered by many to be "the father of surgery". Originating from a family of barber-surgeons, he unraveled the secrets surgery at an early age, and he masters it by participating in the many military actions of the French Army of those times. As recognition of his merits, the kings of France proclaimed him their chief barber-surgeon and even president of the Royal College of French Surgeons. He was a doctor endowed with many qualities and contributed to the development of many medical specialties. Ambroise Paré has brought many contributions and innovations to the development of medicine. Worldwide, his name is closely related to the use of surgical hemostasis. As a true Professor, he offered his entire medical experience through the publication of 25 manuscripts that address various medical specialties. Perseverant and perfectionist by nature, Ambroise Paré represents a true role model for generations of surgeons to come.
... Amputation is the intentional surgical removal of a limb or body part. 1 It is one of the oldest surgical procedures known to mankind. 2 Pakistan is a front line ally in the global war against terrorism since 2002. 3 More than 6600 security personnel have sacrificed their lives while many more have sustained long term permanent disabilities. ...
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... It is widely known that limb amputation represents one of the oldest and most serious surgical operations [1]. There have been various reasons cited for the execution of limb amputation over the centuries (such as traumatic injuries, infections, gangrene, punishment for people who committed crimes, vascular disorders, diabetes mellitus, and malignancies). ...
... The earliest human remains with evidence of an amputation, dated approximately in 4900 BC, were found in Buthiers-Boulancourt near Paris [9][10][11]. The remains were a skeleton of a male who was lacking bones in the left forearm, wrist, and hand. ...
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... Briefly speaking, the maturation process and major evolution of the surgical techniques of limb amputation have been made from the 16th to the 18th century. 40 During that period, the artery forceps and vessel ligation were introduced by Pare, and soon afterwards Morell introduced the tourniquet to reduce the bleeding. As of today, lower limb amputation can be called a ripe and meticulous surgery. ...
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... The muscles and bone then were cut at the same level proximally. This technique was adopted and refined by English, Austrian, and Prussian surgeons [92, 125]. Petit's second contribution was the modified tourniquet, with a screw to adjust tension, making bleeding during an amputation manageable (Fig. 6) [60]. ...
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Thesis
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Amputation has been practised since neolithic times for punitive, therapeutic and ritualistic reasons. Until the development and adoption of general anaesthesia, it was the most major operation to which a surgeon could aspire and a speedy technique was essential. Many famous names have been associated with this operation in both military and civilian surgery.amputation,surgical history.
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The amputation of a limb is one of the oldest surgical procedures. In the course of medical history operative techniques and surgical instruments have been improved continuously. As early as the first century Celsus described an amputation. A major step in the development of the operative technique was the introduction of an artery forceps by Paré during the sixteenth century. Nevertheless, due to a lack of analgesics and narcotics the operation had to take only a few minutes. Therefore the amputation was completed in one cut (i.e., detachment of the skin, muscles, and bone at the same level). This technique, known as "classic circular cut," was modified several times in the following period: to reduce suture tension Petit recommended that we transect the skin first and the muscles and bone more proximally ("two-stage circular cut," 1718), and Bromfield approved that the skin be cut first, the muscles more proximally and the bone most proximal ("three-stage circular cut," 1773). Lowdham (1679), Verduyn (1696), and Langenbeck (1810) changed the operative technique in that they used a soft-tissue flap to cover the bone without tension ("flap amputation").