Amputation of the lower extremity is an ancient procedure, perhaps the oldest surgical operation known to man. Formerly used principally in war, where many a young Paré or Larrey got his start, evolution of our so-called civilization has seen it applied more frequently in civilian life. As such, the main disease that concerns us is arteriosclerosis obliterans causing gangrene or pregangrene. Operations on aged persons who suffer from a disseminated blockage of arteries inevitably carry a high mortality, not only in the conventional sense but in terms of life expectancy.
Inevitably, the knowledge that these patients are running out of time tends to engender an attitude of complacency, and we must guard against it. We must avoid thinking of the amputation for gangrene as an end-of-the-road procedure, a tidying-up done for convenience. Several points need stressing, or, rather, repeating, which, I believe, should be obligations of the surgeon working in