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Limb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score.
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1990
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AmputationLimb ReconstructionTraumatologyLower Limb TraumaVascular TraumaSurgeryLower ExtremityOrthopaedic SurgeryClinical InjuryVascular SurgeryOrthopaedicsLimb LengtheningTrauma Center CareMess ScoreKnee InjuriesTrauma SurgeryRehabilitationLimb RestorationObjective CriteriaPatient SafetyLower Extremity WoundPreliminary ResultsWound HealingMedicineEmergency Medicine
Objective criteria can predict amputation after lower‑extremity trauma. The study tested whether early objective data could distinguish salvageable from unsalvageable lower‑extremity limbs with vascular compromise. The Mangled Extremity Severity Score was created from 25 trauma cases, using skeletal/soft‑tissue injury, limb ischemia, shock, and age to assign points, and was then prospectively evaluated in 26 open fractures with vascular injury. Higher MESS scores were strongly associated with amputation, with a score ≥7 predicting amputation 100% of the time and accurately distinguishing salvageable from unsalvageable limbs.
Objective criteria can predict amputation after lower-extremity trauma. The authors examined the hypothesis that objective data, available early in the evaluation of patients with severe skeletal/soft-tissue injuries of the lower extremity with vascular compromise, might discriminate the salvageable from the unsalvageable limbs. The Mangled Extremity Severity Score (MESS) was developed by reviewing 25 trauma victims with 26 severe lower-extremity open fractures with vascular compromise. The four significant criteria (with increasing points for worsening prognosis) were skeletal/soft-tissue injury, limb ischemia, shock, and patient age. (There was a significant difference in the mean MESS scores; 4.88 in 17 limbs salvaged and 9.11 in nine limbs amputated; p less than 0.01). This scoring system was then prospectively evaluated in 26 lower-extremity open fractures with vascular injury over a 12-month period at two trauma centers. Again, there was a significant difference in the mean MESS scores; 4.00 for the 14 salvaged limbs and 8.83 for the 12 amputated limbs (p less than 0.01). In both the prospective and retrospective studies, a MESS score of greater than or equal to 7 had a 100% predictable value for amputation. This relatively simple, readily available scoring system of objective criteria was highly accurate in acutely discriminating between limbs that were salvageable and those that were unsalvageable and better managed by primary amputation.