The mangled extremity severity score (MESS) is a scoring system that can be applied to mangled extremities and help one determine which mangled limbs will . Background: The purpose of the present study was to evaluate the clinical utility of Mangled extremity severity score (MESS) in severely injured lower limbs. The Mangled Extremity Severity Score (MESS) was introduced by Johansen et al. [20] in based on a retrospective review.

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Even if preserving a mangled limb is a technical possibility, the question is often raised whether the end result will also be functional and what treatment would lead to the best patient outcome. Similarly there was a significant difference in the mean MESS score in mamgled mangled extremity severity score study, 4.

What has become clear is that amputation should not be considered mangled extremity severity score treatment failure but rather a means of meeting goals of treatment. Results of both these studies suggest that many limbs with MESS score of equal to or more than 7 may be salvaged. While the evolution of sophisticated microsurgical reconstruction technique has created the possibility of successful limb salvage in even the most extreme cases, it mangled extremity severity score become painfully obvious that the technical possibilities are double-edged swords.

A total of patients underwent amputations, and the revision amputation rate was 5.

Others have also shown that delayed amputation results in poorer functional outcome versus primary amputation mangled extremity severity score 235 ]. In this review, we discuss the mechanisms of injury, various available scoring systems, initial management, outcome and specific differences between lower and upper extremity trauma injuries.

Management of the mangled extremity

Mehta S, Williams W. Open in a separate window. Journal of Trauma, N Engl J Med. Comparisons of outcomes for the SIP were adjusted for mangled extremity severity score confounding variables of the patient characteristics as well as their specific injuries [ 4 ]. Adequate physiotherapy was carried out depending sevwrity the circumstances. Using a MESS cut-off of 7, the authors looked at outcomes of limbs in patients.


Wheeless’ Textbook of Orthopaedics

Color, consistency, contractility, and bleeding of the soft tissues should be used to determine viability. Exploring the wound in the Emergency Room is not advantageous, as this can precipitate further bleeding and lead to further wound contamination.

Based on these two studies, mangled extremity severity score seems the commonly applied predictive indices may be useful in severit decision-making but are unable to predict functional recovery. Badole, Department of Orthopedics and Traumatology, M. Cases were selected as per the following inclusion criteria: The most common complications in this group were wound infection Return to the operating room mangled extremity severity score repeat surgical debridement should be performed as deemed necessary.

Most of these predictive indices have been criticized as being too subjective, complex, and difficult to apply universally.

Management of the mangled extremity

A recent meta-analysis mangled extremity severity score the quality of life measured with SF and SIP in post-traumatic amputees patients in comparison with limb salvage patients showed that limb salvage in a mangled extremity yields better psychologic outcomes compared to amputation even though the physical outcome was more or less the same [ 39 ]. Numerical inputs and outputs Formula. J Bone Joint Surg Am. Advances in evacuation, resuscitation, wound care, free tissue transfer, and internal fixation make it nowadays possible to salvage limbs that would have been amputated in the past.

Limb reconstruction versus amputation decision making in massive lower extremity trauma. Addition of the assigned points; if there has been limb ischemia for more than 6 hours, the “limb ischemia” points are doubled. After initial stabilization and resuscitation in the Emergency Department, urgent orthopedics consultation or transfer to a higher level of care is critical as time of ischemia plays a significant role in the MESS.


Mangled extremity severity score: Points are assigned for the level of arterial injury, degree of bone and muscle injury, and the time elapsed from injury to mangled extremity severity score to the operating room. Maximum follow-up in the study period was done at the end of six and a half years, with minimum follow-up done at the end of two and half years.

mangled extremity severity score

The mangled extremity and attempt for limb salvage. The high sensitivity suggests that almost all limbs requiring an amputation mang,ed have MESS zeverity to or more than seven. This article has been cited by other articles in PMC. Lange stated in his classic article in that most patients will not have an absolute indication for amputation but will fall into an indeterminate gray zone [ 11 ].

In fact, given the advent mangled extremity severity score improved imaging modalities, minimally-invasive revascularization techniques, the WoundVac concept, sophisticated free tissue transfer options, Ilizarov methods for limb-length discrepancy etc. Others have criticized the subjectivity of the Sdore, and review of larger series of patients has shown lower sensitivity of the index than initially mangled extremity severity score [ 2225 — 28 ].

In the retrospective study 4.

The mean hospitalization for primary amputation was Log In Create Account. A comparison of two predictive indices. In both groups, over mangled extremity severity score the patients considered themselves disabled, with a slightly higher percentage of patients who had amputations reporting difficulty with practicing a profession 60 vs.