AM'PUTA'TION (Lat. aanputare, to lop off, cut around). The cutting off of a part which, by its condition, endangers the safety, health or comfort of the patient. Injury, gangrene, and malignant growths are the most frequent causes for amputation. The amputation of a limb was in ancient times attended with great danger of the patient dying during its performance, as sur geons 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 con trolling the hemorrhage was obtained by the in vention of the ligature by Pare in the sixteenth century, and by the invention of the tourni quet (q.v.) in 1674 by a French surgeon, Morel]. The ancient surgeons endeavored to save a covering of skin for the stump, hav ing the skin drawn upward by an assistant previously to using the knife. In 1679, Lowd
ham, 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 hone. Both these methods are now in use, and are known as the "circular" and the "flap" operations; the latter is most frequently used.
A "flap" amputation is performed thus: The patient being placed in the most convenient posi tion, an assistant compresses the main artery of the limb with an elastic band or a tourniquet. Another assistant supports the limb. The sur geon with one hand lifts the tissue from the bone, and transfixing with a long narrow- knife, cuts rapidly downward and toward the surface of the skin, forming a flap; he then repeats this on the other side of the limb. An assist ant 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 draw ing it slightly from the tissues, an assistant ties it with a thread. All the vessels being se cured with ligatures, after removal of the tourni quet, the flaps are stitched together with a needle and thread, or, if heavy, with silver wire. A suitable dressing is then applied.