AMPUTATION
AMPUTA’TION (Lat. amputo, I lop or prune) is the cutting off of a part which, by its diseased condition, endangers, or may en- I danger, the safety of the whole body. The A. of a limb was in ancient times attended with great danger of the patient’s dying during its performance, as surgeons had no efficient means of restraining the bleeding. They rarely ventured to remove a large portion of a limb, and when they did so, they cut in the gangrened parts, where they knew the vessels would not bleed; the smaller limbs they chopped off with a mallet and chisel; and in both cases-had hot irons at hand with which to sear the raw surfaces, boiling-oil in which to dip the stump, and various resins, mosses, and fungi, supposed to possess the power of arresting hæmorrhage. Some tightly bandaged the limbs they wished to remove, so that they mortified and dropped off; and others amputated with red hot knives, or knives made of wood or horn dipped in vitriol. The desired power of controlling the hæmorrhage was obtained by the invention of the tourniquet (q. v.) in 1674′by a French surgeon Morell. The ancient surgeons endeavored to save a covering of skin for the stump, by having the skin drawn upwards by an assistant, previously to using the knife. In 1679, Lowdham of Exeter suggested cutting semi-circular flaps on one or both sides of a limb, so as to preserve a fleshy cushion to cover the end of the bone.. Both these methods are now in use, and are known as the ‘circular’ and the ‘flap’ operations: the latter is most frequently used in this country.
A ‘ flap’ amputation is performed thus : The patient being placed; in the most convenient position, an assistant compresses the main artery of the limb with his thumb, or a tourniquet is adjusted over it. Another assistant supports the limb. The surgeon with. one hand lifts the tissues from the bone, and transfixing them with a long narrow knife, cuts rapidly downwards and towards the surface of the skin, forming a flap; he then repeats this on the other side of the limb. An assistant now draws up these flaps, and the knife is carried round the bone, dividing any flesh still adhering to it. The surgeon now saws the bone. He then, with a small forceps, seizes the end of the main artery, and drawing it slightly from the tissues, an assistant ties it with a thread. All the vessels being secured the flaps are stitched together with a needle and thread, and a piece of wet lint is laid over the wound. An expert surgeon can remove a limb thus in from 30 to 60 seconds.