The first surgical amputation likely occurred thousands of years ago, with the first evidence of amputation being cave drawings from 5000 BC, Europe. Throughout history, many cultures frowned upon amputation. Some cultures believed that if a limb were removed, it would remain removed in the next life, while in some middle eastern countries, amputating hands was a punishment for thievery.
Amputation techniques have developed slowly in the last few thousand years. The first documented amputations utilised cocaine or opium for analgesia and a guillotine to remove the limb. When a guillotine and cocaine were not readily available, the barber-surgeons would instead use a sharp knife and saw, impressively performing an above-knee amputation in less than 4 minutes. From the 7th century, bleeding and wound infections were primarily managed with boiling oil. If bleeding could not be controlled with boiling oil, then cautery with hot iron would be used. Hippocrates was the first to describe using ligatures to manage bleeding in 400BC. However, this technique was not utilised to manage bleeding from amputation for another 2000 years.
From 1500 to 1700, barber-surgeons aspired to complete amputations in one cut. They would restrain the patient and adopt a “one-stage circular-cut” method to remove the leg. In 1740 this technique was replaced by the “two-stage circular-cut” method, and in 1773, the “three-stage circular-cut” method. Flap techniques were developed around the same time, with double flap amputation gaining the most popularity. These new techniques allowed for better wound closure and pressure offloading. In the last century, amputation has developed more rapidly with the introduction of osteoplastic procedures and myodesis. These advancements have allowed better weight-bearing and pressure offloading for prosthesis and rehabilitation.