Medicine: Instant Prostheses

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In 1963, Polish Surgeon Marian A. Weiss told an international meeting of orthopedists in Copenhagen that he and a French surgeon were fitting artificial legs while patients were still on the operating table—and still under anesthetic for their amputations. To most of his American listeners, Weiss seemed far off base. In U.S. experience, it always took from three months to a year to let a stump heal and to fit a permanent prosthesis on which the patient could learn to walk.

Less than three years later, the revolutionary technique is being used in half a dozen U.S. medical centers from Seattle to Miami. Government cash is speeding the process; the Veterans Administration is especially interested. More than 200 American patients—aged 2 to 82—have now been on their feet within 48 hours after an amputation, and most of them actually walking.

Pounding Pain. A typical case is that of Ward B. Myers, 38, who was supervising a construction job in Port Angeles, Wash., when his right foot was mashed in a boring machine. The foot became infected, causing osteomyelitis, and surgeons in Seattle's Swedish Hospital spent almost a year trying to save the leg. Myers endured twelve operations and almost constant pain—"like a toothache, it just kept pounding away." Early last month Dr. Ernest M. Burgess, whose team has had more experience with instant prostheses than any other U.S. surgeons, decided that the time had come to amputate Myers' leg and get him walking—fast.

In contrast with the recent practice of amputating above the knee, the Burgess team operated as far below the joint as possible, while still avoiding infected bone. After dressing the sutured stump to stanch bleeding, the surgeons used an elastic bandage soaked with plaster of paris to mold a cast around the stump and up Myers' thigh. Into the cast they built an aluminum socket, ready for insertion of a temporary aluminum column of adjustable length.

Next day the peg leg was inserted in the socket and Myers was helped to his feet. He felt only a little discomfort, and on the second day no pain at all. Within ten days he was walking to the barber shop, several blocks away; the next week the surgeons removed the stitches and snapped a new socket snugly to the stump, which had never been appreciably swollen. With this temporary rig, Myers went dancing. Last week orthopedic engineers machined a permanent artificial leg on which Myers wears an ordinary shoe, and he walks well without canes.

Running Children. Some surgeons question whether instant prosthesis is advisable for elderly, debilitated victims of diabetic or other blood-vessel disease. At Miami's James M. Jackson Memo rial Hospital, on the other hand, Dr. Augusto Sarmiento has used the technique on more than 50 such patients aged 60 and over. Only three patients have needed a second (higher) amputation because of infection or poor circulation. Unlike some other surgeons, Dr. Sarmiento does not believe in leaving a drain tube in the wound, or in putting any padding between the stump and the socket. He wants the snuggest possible fit.