With regard to TB1, we infer that the Late Pleistocene ‘surgeon(s)’ who amputated this individual’s lower left leg must have possessed detailed knowledge of limb anatomy and muscular and vascular systems to prevent fatal blood loss and infection. They must also have understood the necessity to remove the limb for survival29. Finally, during surgery, the surrounding tissue including veins, vessels and nerves, were exposed and negotiated in such a way that allowed this individual to not only survive but also continue living with altered mobility. Intensive post-operative nursing and care would have been vital, such as temperature regulation, regular feeding, bathing, and movement to prevent bed sores while the individual was immobile29. The wound would have been regularly cleaned, dressed, and disinfected, perhaps using locally available botanical resources with medicinal properties to prevent infection and provide anaesthetics for pain relief 30,31. Although it is not possible to determine whether infection occurred after the surgery, this individual evidently did not suffer from an infection severe enough to leave permanent skeletal markers and/or cause death. Furthermore, it is inferred that life without a lower limb (combined with other traumas; Extended Data Figs. 7–9 and Supplementary Information) in a rugged and mountainous karst terrain presented a series of practical challenges—several of which can be assumed to have been overcome by a high degree of community care32,33.