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Amputation history, causes, process
Amputation means artificially separating a body part from the body, usually surgically, to save a person's life, or when the severed part can not heal, or as a punishment.
contents
- Origins in the Stone Age
- Firearms and fatal inflammations
- Modern warfare surgery
- What amputations are there?
- How is an amputation??
- Special amputations
- Notamputationen
- Amputation as a punishment
Origins in the Stone Age
Amputations are among the earliest medical measures we know, and even the Stone Age people parted body parts - 10,000 years ago.
Amputee leg. Walking aids allow a normal life. (Image: ottoblotto / fotolia.com) In the advanced civilizations of the Middle East and the Old Testament, the beating off of the hand was the punishment for theft, proving that amputations were common here as well.
Cornelius Celsus (50 BC to 50 AD) discussed cutting away as a medical method: "We use a knife to make a cut to the bone between the healthy and the diseased tissue (...) rather a piece of healthy tissue is cut away than a piece of diseased tissue stops. "
The Greco-Roman doctors knew various treatments to cure the amputation wound. Thus, the surgeon Archigenes thought it right to cut off the limb before the amputation and then burn it out with a cautery.
The scholars argued that only the diseased or healthy part of the limb should be severed. In practice, however, the Romans almost exclusively amputated the diseased section, which probably led to the wound becoming infected.
In addition, the ancient peoples already used prostheses. Thus shows the shard of a vase from the Italy of the 4th century BC. A man with an amputated lower leg, wearing a wooden prosthesis, and Herodotus had already been writing from a wooden foot a century before. Pliny then reports in the 3rd c. From a soldier carrying a hand of iron.
Firearms and fatal inflammations
In the Middle Ages, there were ample reasons to amputate body parts. Leprosy patients rotted body parts alive, dog bites became inflamed, gangrene was omnipresent in the wars.
The doctors in Germany did not know the discussion of antiquity until early modern times and only cut away the gangrenous tissue. The only instruments used were knives, amputation saw, pliers and chisels. No one knew about the danger of viruses or bacteria, and the germ-infested tools pushed patients even more in the direction of exitus. The wound closed the doctors with a branding iron. Although the heat closed the vessels, but could cause new injuries and inflammation.
Experts in amputations and their treatment became executioners. Executioners were not only responsible for executing penalties such as cutting off their hands. Such now barbarous mutilations were not arbitrary, but a crime was considered a disturbance of the order desired by God: The punishment was not the individual, but should restore the divine order.
Therefore, the executioner had to execute the punishment according to a well-defined ritual. So if he amputated a limb, the wound was inflamed and the delinquent died, the executioner had committed a crime that he could hardly make up.
Executioners were also the only ones who knew about human anatomy. The learned doctors were prohibited from dissecting corpses and was considered blasphemy. However, the executioners slashed corpses and sold the "magical medicine" they extracted, and when they put thumbscrews, bones, or weights on the chest, they had to know exactly how that 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 era expired. The victims sat down, they only got opium and henbane for stunning. When the limb was severed, the doctor pulled the bladder of a cattle or pig over the stump.
Except for war wounded physicians usually amputated only when the gangrene had already broken out or the wound had become infected. Most people who have undergone amputation have died during or after surgery, blood loss, or the wound.
Only the surgeon Ambroise Paré prevented the bleeding by blocking the blood vessels with triangular needles. The Swiss physician Fabricius Hildanus also urged to amputate in healthy tissue and to seal the stump with linen. The Englishman Lowdham used a flesh instead of cloth.
Götz von Berlichingen (1480 - 1562) not only survived the loss of his hand in 1504, but he also had a refined prosthesis made of iron. Their fingers fixed cogwheels. The robber knight could even adjust the iron hand to grasp his sword.
Modern warfare surgery
The guillotine replaced in the French Revolution, the medieval mutilations and death penalties such as wheels, quarters or hands off. While amputation as a punishment in Europe so no longer played a role in modern material war, it was one of the essential practices of medicine.
Cannons and shrapnel projectiles ripped apart their bodies, arms or legs severed or severed, hands, feet and faces were the grim face of modern times, with masses marching against masses.
So it was no coincidence that the doctors on the battlefields further developed the amputation. Decisive was the chief physician of Napoleon, Dominique Jean Larrey (1766-1842). He operated directly on the spot before the infection started.
Robert Liston (1794-1847) developed knives that cut through skin, tendons and muscles to the bone with one incision, the surgeon suddenly cut around the entire limb. Liston also used narcosis instead of speed.
In the two world wars, the development of prostheses made great progress. Ferdinand Sauerbruch (1875-1951) put a skin tunnel through his upper arm and pushed through an elven birch pin. This lifted when the muscle tensed, and the hand reached out.
Since the 1960s, electrodes have been measuring electrical impulses of the arm muscle and passing them on to motors that move their fingers. Today you can even feel with hand prostheses.
In 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 disruption of circulation, injuries and infections - especially atherosclerosis. The lower part of the legs is at greatest 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 announce sepsis and all other methods fail. Where amputated depends on the quality of the blood flow in the respective parts of the body. The thigh is usually amputated a hand's breadth above the knee, the lower leg a hand's breadth below it.
Very rarely, physicians amputate today in accidents. The goal is always to maintain the limbs, and the current state of the art makes it possible to reimplant even severed parts of limbs again. However, if the body part is destroyed, the doctors can only treat the stump.
Uncontrolled infections of wounds and open fractures of grade IV make amputation inevitable.
Even malignant tumors sometimes require the amputation of a limb, usually in bone or soft tissue cancer.
How is an amputation??
A planned amputation is designed so that the stump can be well supplied. The bones must be covered with soft tissue, and the skin incision is below the amputation on the bone - doctors speak of frog incision. Once the bone is severed, the surgeon smoothes the bony edges. The muscles then surround the stump of the bone, and the physician connects the muscles.
After that, it's about avoiding infections. Occlusive disease and diabetes, the two major causes of amputations, often cause problems in healing the wound.
The stump fixes the doctor with a special bandage. If the wound heals, the physician applies an elastic sheath, and above this he will later attach the prosthesis stem.
The Krukenberg gripping pliers use spoke and jaw to grasp. In amputations of the forearm, these bones "replace" the hand.
Special amputations
In the Pirogoff amputation, the foot is amputated, but the heel bone and parts of the foot are retained.
The Gritti-Stokes amputation is an amputation on the thigh in the immediate vicinity of the knee joint. The kneecap remains intact, the surgeon pushes it under the stump fxiert it there and sewn the patellar tendon with the knee flexor tendons. The stump becomes long and elastic.
Notamputationen
Emergency physicians sometimes have to amputate directly at the scene of the accident, especially in case of spills, if there is no technical rescue in sight, the affected persons have clamped limbs and are in mortal danger.
Amputations of "diabetic feet" are relatively common. Picture: ittipol - fotolia The ambulance doctor ensures that the vital functions remain intact, for example, he places the patient in a lateral position, ventilating or reviving him if the situation requires it.
The separated part of the body is carefully preserved in germ-free material. If possible, the amputate is transported cool to keep it in the shape it had in the accident. It comes in a plastic bag, and this comes in another bag in which ice is. The ice must not come into contact with the tissue to prevent frostbite.
Amputation as a punishment
Today there are cutting away limbs as a punishment only under Islamic rule. According to Sura 5:38 of the Koran, thieves are to be cut off by hand, according to Sura 5:33 for street robbery and the fight against the messengers of God's hand and foot. In historic Islam, judges seldom imposed both sentences, and at the turn of the 20th century, almost all states abolished these sentences.
Unbroken, the amputations held only in Saudi Arabia under the rule of the Wahhabis. The triumphal march of Islamists since 1972 brought repulsions in Libya, Pakistan, Iran, Sudan and parts of Nigeria, the repulsion of hands and feet in the prison; in Sudan alone, between 1983 and 1985, 120 amputations occurred. The practice continues today. (Dr. Utz Anhalt)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)