The history of surgical instruments: 8. The instruments and the evolution of operative techniques of amputation with an example of an amputation caseof the nineteenth century

The amputation of a limb is one of the oldest surgical procedures. However, in the course of medical history operative techniques and surgical instrum ents have been improved continuously. With an example of an amputation case of the last century we will summarize this development until the middle of the nineteenth century. Even in the first century Celsus gave a descriptio n of an amputation (circular cut). A major step in the development of the o perative technique was the introduction of artery forceps by A. Pare in the sixteenth century. Nevertheless, due to a lack of analgesics and narcotics the operation had to take only a few minutes. Therefore the amputation was completed in one cut, i.e. detachment of the skin, muscles and bone at the same level. This technique known as "classic circular cut" was modified se veral times in the following period: in order to reduce suture tension Peti t recommended to transect the skin first and the muscles and bone more prox imal ("two-stage cicurlar cut", 1718) and Bromfield approved to cut in turn the skin first, the muscles more proximal and the bone most proximal ("thr ee-stage circular cut", 1773). Finally, Lowdham (1679), Verduyn (1696) and C. J. M. Langenbeck (1810) changed the operative technique to the effect th at they used a soft-tissue flap in order to cover the bone without tension ("flap amputation").