Evidence of a leg amputation performed on a prehistoric person 31,000 years ago has blown the known history of surgery out of the water.
A team of Indonesian and Australian archaeologists discovered the skeletal remains of a young hunter-gatherer in a limestone cave on the island of Borneo.
The cave also contained rock art which included hand prints.
This prehistoric person had their lower left leg surgically removed as a child.
The procedure was quite complex and showed many of the signs modern surgeons would employ in amputations today.
There's also speculation these prehistoric people may have known about anaesthetic, anti-bacterial and the antiseptic benefits of plants growing close to the site.
Up until this discovery, the oldest evidence yet revealed for amputation surgery had comprised the 7,000-year-old skeleton of an elderly male Stone Age farmer from France, whose left forearm had been carefully amputated just above the elbow.
The archaeological team was co-led by Griffith University academics, but the job of dating the skeleton was left to Associate Professor Renaud Joannes-Boyau, Head of the Geoarchaeology and Archaeometry Research Group at Southern Cross University.
"Dating the remains directly turned out to be a challenging task," Associate Professor Renaud said.
"At time we didn't yet know about the surgical amputation. We still analysed it and were already excited that is was the oldest burial in South East Asia.
"Later on when we found it was the oldest surgical amputation, it was definitely very exciting to be part of this process."
Although archaeologists don't yet know whether this prehistoric medical miracle was a man or woman, they can tell they had their leg amputated as a young child and lived to adulthood.
"The amputation happened around seven or eight years old, because the tibia of that person never fully developed," Associate Professor Renaud said.
"He or she's tibia stayed the same on that side and stayed the size of a child, while the other side developed into full adulthood.
"They lived into their late 20s."
What's also remarkable about this discovery is that this prehistoric person also had a cracked vertebrae in their neck, meaning the rest of the community must have looked after them into adulthood.
"It is possible the amputation and neck fracture happened at the same time, in a fall or something, but the truth is we don't know." Associate Professor Renaud said.
"We do know the leg was removed properly and surgically and we know they survived.
"This person had mobility issues and and had to be cared for."
The surgeon or surgeons who performed the operation 31,000 years ago must have had detailed knowledge of limb anatomy and muscular and vascular systems to avoid veins, vessels, and nerves and prevent fatal blood loss and infection.
Intensive post-operative nursing and care would also have been vital, and the wound would have had to have been regularly cleaned and disinfected to prevent infection.
Regular amputation success in modern medicine didn't arrive until the turn of the previous century following the discovery of antiseptics.
The skeleton was well preserved, likely because it was intentionally deposited into a burial site.
The new finding was brought to light in 2020 during an archaeological excavation at Liang Tebo.
Liang Tebo is a limestone cave in the remote Sangkulirang-Mangkalihat region of eastern Kalimantan, the Indonesian portion of Borneo, which is accessible only by boat at certain times of the year.
The archaeological excavation was overseen by Griffith researcher Dr Tim Maloney, along with Dr India Ella Dilkes-Hall (University of Western Australia) and Mr Andika Priyatno (Balai Pelestarian Cagar Budaya), with the field team surprised to observe that the human skeleton was missing its left foot and lower leg.
Previously, archaeological research across Eurasia and the Americas had uncovered human bones that bore signs of prehistoric surgeries, including holes drilled in skulls (trepanation).
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