Amputation in military trauma surgery.

BACKGROUND: Major limb amputations are among the most debilitating wounds sustained by those who survive a combat injury and these injuries leave a lasting impression with the public. This article will review the history of major limb amputation in military trauma surgery.
METHODS: Review of published historic and modern battle casualty information was undertaken in the collections of the medical library of the National Naval Medical Center and the National Library of Medicine, both in Bethesda, Maryland, and the University of Maryland Health Sciences Center in Baltimore, Maryland.
RESULTS: The potential utility of major limb amputation as a life-saving surgical intervention for compound fractures and other devastating limb injuries has been recognized through much of written human history. However, the advent of gunpowder onto the battlefields of Europe in the 14th century forced surgeons to solve the problems of, first, hemorrhage and then, as casualties survived the initial surgery, sepsis for amputation to actually improve outcomes. In the latter half of the 20th century, rapid evacuation from the battlefield and successful neurovascular repair has reduced the need for major limb amputations essentially for those required by insurmountable tissue loss.
CONCLUSIONS: Major limb amputation remains a fearsome outcome of limb injury. However, during the last 500 years, military trauma surgeons have solved the problems of bleeding, infection, and neurovascular repair after major limb injury such that amputation rates even during times of active military conflict are at historic lows.