Was just reading on pre 20th century amputations and how they strived to be as fast as possible, cutting through bone and all.
Why didn’t they just amputate at the joint, like a butcher cuts pork or beef? That would have been way faster than sawing off though bone.
In: 8
Ever hear about the guy with a 300% mortality rate on a single amputation surgery?
https://historycolored.com/articles/7381/how-did-surgeon-robert-liston-accidentally-kill-three-people-in-one-day/#:~:text=Robert%20Liston%20was%20known%20as,pain%20and%20shock%20would%20kill.
Butcher isnt exactly worried about how his patients will function when hes finished. A bit more finesse is needed.
That’s literally what they did, because cutting through bone EXPONENTIALLY increased risk of infection and death. They made a specific tool called an amputation knife (not a liston knife) that was meant to cut away the flesh at a joint and you would use a chisel or other implement to cut through the joint.
They need to leave enough skin to cover the stump and also if possible connect the arteries to the veins to maintain a good blood supply. And try to avoid nerve clusters so as not to leave the patient begging for death if they survive the Op. It was hellish and if you watch some detailed and demonstrative videos, of the kind youtube no longer allows, you’ll understand why some people chose death rather than amputation, and why a surgeon with a good tourne-de-maestro was worth paying for.
The stump needs to have a specific shape to be able to use prosthetics and also extra skin needs to be left in order to close the wound. Lastly stopping the bleeding and bandaging such a wound is very difficult and would lead to certain death from infection in earlier times
A follow up ELI5 to this question would be why didn’t they use a guillotine for fastest possible and cleanest cut?
Years ago, I had a fascinating conversation with a Revolutionary War historian who told me in those days, amputations were most often performed by someone with experience as a butcher but were overseen by a doctor [who in those days were book worms, according to the historian, and had little hands-on surgical training. Guys who managed infections like Lister and real surgeons like the Mayo brothers didn’t appear until the second half of the 1800’s].
Preserving skin to make a flap and keeping some tissue to fold over for a stump were key, so amputations started relatively slowly, but gained speed as the flap was folded back and the surgeon/butcher moved through more tissue, tied off what he could and then cut the bone. I didn’t think to ask at the time what happened to tendons. I’m guessing they’d leave them intact if they could. Time spent with a tourniquet on a limb had to be limited in order to not kill tissue needed for the stump, so there must have been some element to “do what you can”.
[Skip this if you get grossed out easily]:
I was interested to learn that a set of “z” shaped stitches were used to close amputations. Not super tight, with the edges of the wound pulled together to allow for some bleeding. The skin was not folded inward to make a tight closure like today. Instead, the flexible stitch would allow the wound to stretch a little and also allow it to open and let infection, if any, weep out.
ELI5 answer: (I’m an orthopedic surgeon for reference) For leg amputations which are the most common its because its harder to fit prosthesis over an actual joint because its very bulky, its easier and more functional to do it above the knee or below the knee
Adult answer:
I’m seeing a lot of half true answers.
The truth is we DO do some amputations through the joint, they are called disarticulations, you can do a hip, knee, or ankle disarticulation for a number of reason. In pediatric patients a knee disarticulation can sometimes be more beneficial than an above knee or below knee amputation.
The main reason we don’t do these typically has nothing to do with the blood supply, you have to identify the vessels and nerves no matter where you do the amputation, its about the prosthesis. With an above knee amputation you can fit a prosthesis with a knee joint, with a below knee amputation you have your own native knee to use. Knee disarticulations are notoriously difficult to fit a prosthesis over.
For upper extremity ampututations it’s a little different because these are not weight bearing joints that have to go through a gait cycle, its more about making the limb as functional as possible for daily activities depending on the demand of the patient, so shoulder, elbow, and wrist disarticulations are more common so we do those relatively frequently (through the joint, not through the bone).
Some doctors realised that there was a link between quick amputations and a chance to live. Infamously, [Robert Liston](https://en.wikipedia.org/wiki/Robert_Liston#Liston’s_most_famous_case) was once so zealous in his speed of amputation that as well as the patient’s leg, he also took with it several of his assistant’s fingers and the coat tails of a spectator.
The patient died, the assistant later died of gangrene, and the spectator was so convinced that he had also been cut that he died of shock. It’s the only known operation that has had a 300% mortality rate.
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There are many other reasons why you’d want to minimise the speed a surgery takes (i.e. most surgeons want to cut precisely for innumerable reasons), but without precision tools, such speed and precision was difficult – usually you’d need to pick one, and most surgeons opted for precision.
Back when executions were done by the axe man… well the axe man misses. It can take multiple swings. It’s pretty horrific.
Remember, the guillotine was invented as a more humane version of execution.
So I really don’t want any surgeon swinging at my body like a leg of lamb.
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