History of Prosthetics and Amputation Surgery
The earliest recorded use
of a lower limb prosthesis was that of a Persian soldier,
Hegesistratus, who cut off his own foot to escape from
stocks in 484 B.C. He apparently replaced his foot with a
wooden foot, as reported by Herodotus. A limb prosthesis has
been used since the beginning of mankind in some form or
another. They were made of whatever resources of the time
were available. The earliest were probably made from a stick
that had some sort of resting area upon which the remaining
limb could sit. As time went on, different materials were
added for padding. I imagine the first padding materials
were leaves and/or animal skins.
The oldest known
prosthesis that was unearthed, was in Capri, Italy, in 1858.
The copper and wood leg was believed to be made around 300
B.C. Unfortunately, this rare find was destroyed in World
War II, during the bombing of London, Great
Britain.
The earliest surgical
amputations were performed for life saving reasons. Ambroise
Pare who is known as the father of modern Orthopedics,
introduced in 1529, techniques that were described by
Hippocrates. Ambroise Pare was a French military surgeon.
They found the rate of survival increased when procedures
using ligatures, or bindings, were used.
The first "elbow
disarticulation" was performed by Ambroise Pare in
1536.
The first "tourniquet"
was used by Morel in 1674. The tourniquet is still used
today in surgery. The new ones are much different and
improved, using a pneumatic system the surgeon can easily
regulate the amount of pressure to be used at any given
moment. The tourniquet is used to slow down the blood flow
during an amputation. They are primarily used during
amputations to reduce blood loss.
The first amputation
through the "ankle" was performed by Sir James Syme in 1843.
Advantages were weight bearing on the bottom of the stump,
sensation and Proprioception (the capability to sense where
your leg is in space, such as, with your eyes closed,
knowing if your leg is flexed or straight).
The first successful "
atmospheric pressure socket" was developed by Dubois L
Parmelee of New York City, in 1863. This would be similar to
suction sockets of today. His technique was to make an exact
copy of the stump, whereas others who attempted to make
sockets before him, did not.
The first "antiseptic"
was used by Lord Lister in 1867. This technique was one of
the best advancements for the success of amputation
surgeries and led to many different substances used then and
still today. Lord Lister happened to be a student of Sir
James Syme and also his son in law. Chloroform and ether
also were used around the same time adding to a more
successful surgery.
The concept of kineplasty
to power upper limbs through muscle contraction was
introduced by Vanghetti, in 1898. Kineplasty would directly
power the prosthesis by muscle attachment. It was first
operation performed on humans and was done in 1900, by
Vanghetti's associate, Ceci. They were trying to improve the
function of Italian soldiers that had lost their hands by
amputations from the Abyssinians.
The development of the
skin lined muscle tunnel was in 1916, by two German
physicians, Sauerbruch and ten Horn. In the 1920's, in
Argentina clinical trials of this procedure were carried
out.
The first weight bearing
technique on cut bones was recommended by Bier, in 1900. His
technique never became common practice. Ertl improved this
technique by adding a bony bridge between the tibia and the
fibula, in the late 1940s. Mondry added the myodesis
technique to Ertl's bony bridge technique, only a few years
later. Myodesis is an technique where opposing cut muscle
groups are sewn together over the distal end of the stump.
The myodesis technique is still used today in most
amputations. The Ertl technique is not used enough and I
believe should be reintroduced. Many amputees could benefit
from this procedure. The bony bridge stabilizes the free
moving distal end of the cut bones. Protects the bottom of
the stump from sharp cut bones, allows some distal weight
bearing. A few physicians helped popularize these procedures
at the time, Dederich, Weiss et al., and others.
At the end of World War
II, General Norman T. Kirk, who was a Orthopedic surgeon,
had military hospitals filled with amputees that were
disappointed with the performance of their prostheses. He
involved the National Academy of Sciences (NAS) to make sure
the amputees got the best care. The NAS realized they needed
a crash research program, since there was very little
science research of late.
The Veterans
Administration took over the research in 1947, they were
also responsible for all of these amputees after discharge
from the military. Many research programs were subcontracted
to Universities.
We will update this in
the near future, please Bookmark this site, because we will
be adding a great deal more in the future.
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