Wartime amputations.

The development of amputation surgery has closely paralleled progress in combat casualty care. Since the Civil War, care at hospitals close to the front lines has been improved by advances in both medical care (safer anesthesia, antibiotics, and fluid resuscitation) and medical field service (field hospitals and evacuation of the wounded). This progress has helped reduce the morbidity and mortality of all combat casualties. Surgical management of patients with amputations has evolved to the open circular technique, which is currently recommended for initial management of battlefield casualties. Because residents are not routinely taught this technique, military surgeons have been forced to relearn it during every conflict since World War II. This paper outlines the indications, techniques, and special postoperative care of amputees from the Civil War through Vietnam.