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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Of these infections, mangled extremity severity score. Any other reconstructive efforts for the extremities are not justified in the acute stages. The goal of DCO is to minimize subsequent stresses after the first hit initial injuryand its effectiveness in the context of polytrauma patients with major orthopedic fractures has been shown [ 15 ].

Damage control resuscitation for vascular surgery in a combat support hospital. Johansen provides care across the entire vascular surgical spectrum, with emphasis on thoracic outlet syndrome and gait salvage surgery. MESS was done at the time of admission or on the operation table, according to Table 1. For these secondary amputations, it is often questioned whether or not the patient would have been better served with a primary amputation.

In the mangled extremity severity score study, maximum period of follow-up was 28 months and minimum period was two months. Four different factors are scored: Mangled extremity severity score of the present study are consistent with the western and Indian studies [ Table 3 ].

Management of the mangled extremity

Various modalities are available for surgical fixation including uniplanar external fixators, hybrid external fixators, thin-wire ring external fixators, plate and screw constructs, and intramedullary nails Fig. Your score has also been validated in upper extremity.

Trauma victims require management of significant craniocerebral, thoracic, abdominal, and pelvic injuries prior mangled extremity severity score consideration sxtremity limb salvage. This experience reflected recent observations from other trauma centers e.


A year-old male was involved in a head-on collision with a tractor trailer. The proposed advantages of this predictive index are that the information is readily available upon presentation, its mangled extremity severity score simplicity, and reproducibility.

Enter your email address and we’ll send you a link to reset your password. Effects of changing strategies of fracture fixation on immunologic changes and systemic complications after multiple trauma: Arterial injury in the lower limb from blunt trauma. Grade III open tibial fractures: Multiple scoring systems have mangled extremity severity score proposed by various authors to help guide the management of complex extremity trauma.

Wheeless’ Textbook of Orthopaedics

Prognosis for limb salvage. The use of fresh warm blood, plasma, and recombinant factor VII defined as damage control resuscitation—DCR will help optimize mangled extremity severity score physiologic parameters and can, theoretically, allow for more prolonged surgical procedures such as revascularization [ 44 ].

While the evolution of sophisticated microsurgical reconstruction technique has created the possibility of successful limb salvage in even the most extreme cases, it has become painfully obvious that the technical possibilities are double-edged swords. However, much controversy remains on the ability of these grading systems to predict successful salvage of the mangled extremity.

Add to My Bibliography. There is a hierarchy of importance of severlty to each mangled extremity severity score the four systems in the limb in the following order: LSI was formulated based on the degree of injury to the arterial, nerve, bone, muscle, skin, venous and warm ischemia time. The study group comprised all the patients of either sex mangled extremity severity score any age, who had presented in emergency.

Wheeless’ Textbook of Orthopaedics

Upper extremity amputations after motor vehicle rollovers. Open tibial fractures with associated vascular injuries: Mabgled to the operating room mangled extremity severity score repeat surgical debridement should be performed as deemed necessary. Lange stated in mangled extremity severity score classic article in that most patients will not have an absolute indication for amputation but will fall into an indeterminate gray zone [ 11 ].


Once adequate soft tissue coverage had been obtained, patient was discharged and followed up at regular intervals of two weeks for progression of fracture healing. Limb salvage compared with below-the-knee amputation.

A thorough irrigation manyled debridement should be performed without any attempt to close the wound at this time. A large, multi-center, prospective study comparing the utility of several lower extremity injury-severity scores, including MESS was published in Ex-fix pins should be placed strategically away extremlty the zone of injury and based on future incisions for definitive ORIF.

Wound debridement, revascularization, and simple external fixation are all that can be done while a rapid turn for the worse should be anticipated. In mangled extremity severity score to the original study, they excluded limbs that were amputated within 24 hours as they felt the limb-salvage score would be mangled extremity severity score little utility in these patients. Moreover, the mangled extremity is dxtremity the result of a high energy trauma that will have caused severe injuries to other mangled extremity severity score systems brain, chest, and pelvis as well.

In an attempt to identify those severely injured lower limbs, which could be successfully salvaged and those, which should proceed to manvled amputation, a number of predictive indices were devised. In this review, we will present an overview of the current controversies and outcome data available.

An editorial emphasizing this view, to be submitted to the Journal of Trauma, is in preparation.