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Limb Salvage Versus Amputation
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1990
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AmputationLimb ReconstructionTraumatologyLower Limb TraumaVascular TraumaSurgeryLower ExtremityOrthopaedic SurgeryClinical InjuryVascular SurgeryLimb LengtheningProsthesisTrauma Center CareMess ScoreTrauma SurgeryLimb RestorationObjective CriteriaArterial ReconstructionsPatient SafetyLower Extremity WoundWound 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 (MESS), based on skeletal/soft‑tissue injury, limb ischemia, shock, and age, was developed from 25 cases and prospectively validated in 26 patients across two trauma centers. Higher MESS scores were significantly associated with amputation, with a score of 27 predicting amputation 100% of the time, demonstrating the score’s high accuracy in 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 < 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 < 0.01). In both the prospective and retrospective studies, a MESS score of 27 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.