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Journal of Bone and Joint Surgery, 1949;31:800-819.
© 1949 by The Journal of Bone and Joint Surgery, Inc

CAUSES FOR AMPUTATIONS PERFORMED AT WALTER REED GENERAL HOSPITAL DURING 1947 AND 1948

August W. Spittler 1 and Lloyd W. Taylor 1

1 Medical Corps, United States Army

1. Unilateral amputation is not a contra-indication to amputation of the contra-lateral extremity. The criteria for amputation should he the same for each extremity under consideration.

2. Skin-grafting of any type to full weight-bearing surfaces is so highly unsatisfactory as to condemn the procedure in general.

3. Elective sacrifice of the fibula in a reconstruction program is highly unsatisfactory and unnecessary, in the light of our knowledge of the favorable results from cancellous bone-grafting.

4. A Syme amputation is the best major amputation through the extremity. It is preferable from a functional standpoint to a complete arthrodesis of the foot, or to any amputation through the tarsal region.

5. When amputation is a possibility, surgical incisions should be so placed as to permit amputation at the lowest possible level, should this procedure become necessary at a future date.

6. When amputation is a possibility, the removal of cancellous graft from the ilium should be done on the affected side, and not on the contralateral side.

7. Needless operative procedures which promised little, if any, possibility of success were performed on the patients studied, causing prolonged months and years of hospitalization, psychological trauma, conversion reaction, and general systemic damage, seceondary to prolonged periods of chronic infection. Early evaluation of these cases and the application of sound surgical principles could have prevented a large proportion of these undesirable problems. The principle most often disregarded in these cases was that amputation is a sound method of treatment and not a last resort.


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P. J. DOUGHERTY
Long-Term Follow-up Study of Bilateral Above-the-Knee Amputees from the Vietnam War*{{dagger}}
J. Bone Joint Surg. Am., October 1, 1999; 81(10): 1384 - 90.
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