Amputation (Lat. amputare, 'to lop' or 'prune') is the cutting off of a part which, by its injured or diseased condition, endangers, or may endanger, the safety of the whole body. The amputation 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 hemorrhage. 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 hemorrhage was obtained by the invention of the Tourniquet (q.v.), in 1674, by a French surgeon, Morel, and its improvement early in the next century by his countryman Petit. The ancient surgeons endeavoured 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 semicircular 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. An expert surgeon can remove a limb thus in from thirty to sixty seconds. He then, with a small forceps, seizes the end of the main artery, and while he draws 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 the wound is dressed.
The question when amputation of a limb is necessary, is often, especially after an accident, one of the most difficult in surgery. The chief indications for it in these cases are—very extensive destruction or laceration of the skin; injury to the large vessels or nerves; severe splintering of the bones. The diseases most commonly requiring it are—disease of bones or joints, especially when the discharge from it threatens to exhaust the patient; tumours, especially cancer and sarcoma, which cannot otherwise be removed; and gangrene.