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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