Abstract
Background:The purpose of the present study was to evaluate the clinical utility of Mangled extremity severity score (MESS) in severely injured lower limbs.Materials and Methods:Retrospectively 25 and prospectively 36 lower limbs in 58 patients with high-energy injuries were evaluated with the use of MESS, to assist in the decision-making process for the care of patients with such injuries. Difference between the mean MESS scores for amputated and salvaged limbs was analyzed.Results:In the retrospective study 4.65 (4.65 ± 1.32) was the mean score for the salvaged limbs and 8.80 (8.8 ± 1.4) for the amputated limbs. In the prospective study 4.53 (4.53 ± 2.44) was the mean score for the salvaged limbs and 8.83 (8.83 ± 2.34) for the amputated limbs. There was a significant difference in the mean scores for salvaged and amputated limbs. Retrospective 21 (84%) and prospective 29 (80.5%) limbs remained in the salvage pathway six months after the injury.Conclusion:MESS could predict amputation of severely injured lower limbs, having score of equal or more than 7 with 91% sensitivity and 98% specificity. There was a significant difference in the mean MESS scores in the prospective study (n=36), 4.53 (4.53 ± 2.44) in thirty salvaged limbs (83.33%) and 8.83 (8.83 ± 2.34) in six amputated limbs (16.66%) with a P-value 0.002 (P-value < 0.01). Similarly there was a significant difference in the mean MESS score in the retrospective study (n=25), 4.65 (4.65 ± 1.32) in twenty salvaged limbs (80%) and 8.80 (8.8 ± 1.4) in five amputated limbs (20%) with a P-value 0.00005 (P-value < 0.01). MESS is a simple and relatively easy and readily available scoring system which can help the surgeon to decide the fate of the lower extremity with a high-energy injury.
Highlights
Massive lower extremity trauma,in particular open tibial fractures with associated vascular injuries, present an immediate and complex decision-making challenge between a limb salvage attempt and primary amputation
MESS is a reliable indicator in decision making process whether a limb can be salvaged or needs amputation
An attempt to quantify the severity of the trauma and to establish numerical guidelines for the decision to amputate or salvage the limb has been proposed by many others
Summary
Massive lower extremity trauma,in particular open tibial fractures with associated vascular injuries, present an immediate and complex decision-making challenge between a limb salvage attempt and primary amputation. Massive lower extremity trauma,in particular open tibial fractures with associated vascular injuries, present an immediate and complex decision-making challenge between limb salvage attempt and primary amputation.[1] Medical and surgical advances of the past two decades have improved the ability to reconstruct severely injured leg. The ideal situation is one which allows identification of those patient who will benefit from early and aggressive attempts at limb salvage and those for whom primary amputation is the correct choice.[2] An attempt to quantify the severity of the trauma and to establish numerical guidelines for the decision to amputate or salvage the limb has been proposed by many others These include the Mangled extremity severity score(MESS),the Predictive Salvage Index, the Limb Salvage Index, thenerve,ischemia, soft tissue injury, skeletal injury and age of patient (NISSA) score and the Hanover fracture scale-97 (HFS-97).[3] Mangled extremity severity score is one of the scoring systems to predict the fate of limbs after severe limb injuries and was found to be the most useful. Mangled extremity severity score is one of the scoring systems to predict the fate of limbs after severe limb injuries and was found to be the most useful. 4, 5
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