The validity of the mangled extremity severity score scoring system for lower limb vascular trauma in a tertiary care center

Abstract

Purpose: Among all the scoring systems to predict limb salvage versus amputation after a complex trauma, MESS scoring system is considered to have good sensitivity and specificity. MESS scoring system is most widely used scoring system for the last more than 25 years. However when we applied MESS scoring system in our set of patients, it would not correlate with the need of amputation (for MESS score more than 7) and resulting in significant number of limb salvage. Methods: This a prospective study of 60 patients over a period of two years from June 2017-June 2019. All the patients of lower limb vascular trauma were examined and operated by the same team involving vascular surgeon, orthopedic surgeon and plastic surgeon. MESS scoring system was applied for all the patients. Patients with life threatening injuries were excluded in this study. Results: Between June 2017-2019, 60 patients were entered into the study. The majority were male with mean age of 30 years (Range 11-65years). Road traffic accidents with open injuries were the commonest mechanism of injuries (60%) and popliteal artery was involved in majority of injuries. Out of 35 patients of MESS score more than 7, in 28 patients leg was salvaged with the help of vascular,orthopedics and plastic reconstructions and remaining 7 patients underwent secondary amputation. The hospital stay and the finances involved in the treatment was high in patients with MESS score more than 7, where revascularisation was performed. However in the end psychological assessment of these patients and their family members was very encouraging. Conclusions: With the availability of a dedicated trauma team (which include vascular, orthopedic, plastic surgeons & anaesthetist) and improvement in the diagnostic and treatment modalities, the rate of limb salvage has increased significantly, hence reducing the prediction of MESS scoring system for an amputation. We conclude from our study that majority of lower limbs were salvaged in spite of MESS score being more than 7. We suggest with a word of caution for an amputation directly with a MESS score of more than 7 in all patients.