Syme’s Amputation

In this latest blog our Human Remains Conservator, Cat Irving, takes a look at James Syme and how his pioneering technique helped shape the surgical world.

Portrait of James Syme.

James Syme (1799-1870) was one of the leading surgeons of his day, whom it was said He never unnecessarily wasted a word, drop of ink or blood.” Active during the golden age of surgery in nineteenth century Edinburgh, he was taught by Robert Liston, who was a friend before they feuded. James Young Simpson was a contemporary, and he was father-in-law to Joseph Lister. One of the procedures he pioneered was amputation at the ankle. Prior to this, problems with injuries or infection of the foot would be treated with amputation at the knee, at a distance of a hand’s breadth below the patella. As this opened the medullary cavities of the tibula and fibula, in the time before antisepsis when the risk of infection was high,  mortality from the operation was between 25 and 50%.

Ulcerated foot removed by Syme’s amputation.

Syme’s procedure, which still carries his name, amputates at the point where the foot meets the ankle, leaving attached the heel pad to cover the end of the tibia, but removing both malleoli-the bony prominences at the ankle. This leaves a stump which will usually have the capability of bearing weight, while also being better suited to prosthesis than that left behind during the amputation below the knee. Syme first performed the procedure on a patient suffering from osteomyelitis of the foot, and first reported on his procedure in February 1843. He said that its advantages were “first that the risk of life will be smaller; second, that a more comfortable stump will be afforded; third, that the limb will be more seemly and useful for the progressive motion.” Syme’s amputation is still performed today.

Section of the tibia in a leg stump following a Syme’s amputation.

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