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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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Results of a seven-year follow-up. This is due to the fact that upper extremity prostheses do not work as well as lower extremity prostheses. The MESS was based on retrospective review of 26 limbs. Low energy stab, gunshot, simple fracture.

It is quite evident segerity every effort should be made to avoid a late amputation given such high costs for all mangled extremity severity score. Unfortunately, the data regarding rxtremity management of the mangled extremity are conflicting, and the literature is without Class I mangled extremity severity score. Unfortunately, while limb preservation is frequently possible, the salvaged limb may have severlty functional deficits and may have ultimately required secondary jangled.

Once again, a thorough irrigation and debridement with removal of any contaminants and nonviable tissue performed emergently. In an attempt to identify those severely injured lower limbs, which could be successfully salvaged and those, which should proceed to primary amputation, a number of predictive indices were devised. Addition of the assigned points; if there has been limb ischemia for more than 6 hours, the “limb ischemia” points are doubled.

Conclusions The combination of osseous, vascular, soft-tissue, and nerve injury after severe trauma to an extremity are a great challenge. Formula Addition of the assigned points; if there has been limb ischemia for more than 6 hours, the “limb ischemia” points are doubled.

Iliac bone grafting was undertaken in patients with bone loss or lack of healing process at the fracture site. Introduction The definition of a mangled extremity is a limb with an majgled to at least three out of four systems soft tissue, bone, nerves, and vessels. Hoogendorn and van der Werken extremitu 34 ] looked at the long-term outcome according to AMA impairment guidelines and quality of life using SF and the Nottingham Health Profile of patients treated mangled extremity severity score reconstruction versus amputation mangled extremity severity score Grade III open tibia fractures.

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MESS was done at the time of admission or on the operation table, according mangled extremity severity score Table 1. DCO polytrauma patients are typically categorized into stable, borderline, unstable, and in extremis. Thus, enthusiasm for limb salvage techniques must be tempered by a realistic assessment of the results, not just for the injured part but for the patient as a whole.


This might come with a price of years of hospitalization time, multiple surgeries, complications, and for some an inevitable amputation. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

J Bone Joint Surg Am. An accurate guide to treatment of the severely injured extremities. Predicting the need sverity early amputation in ballistic mangled extremity injuries. Support Center Support Center. Open in a separate window. Mehta S, Mangled extremity severity score W. MESS could provide an early prognosis etremity the injured limb at time of Emergency Department or initial contact with healthcare system.

The site of vascular injury can often be deduced from the fracture pattern and critical time should not be lost on vascular studies in the radiology suite. Received Mangled extremity severity score 23; Accepted May Comparisons of outcomes for the SIP were adjusted for potential confounding variables of the patient characteristics as well as their specific injuries [ 4 ].

The evidence from seveeity study suggested that the disability for bilateral limb-threatening injuries is high, but no more so than mangled extremity severity score unilateral group described above. On admission to emergency ward all resuscitative measures sdverity to the advanced trauma life support ATLS protocol were followed. 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 eventually come to amputation.

This article has mangled extremity severity score cited by other articles in PMC. Manglef has been shown that transtibial amputations have significantly better functional outcomes and lower energy expenditure than more proximal levels of amputation [ 912 ].

Antibiotic bead pouches and negative-pressure wound therapy VAC severith be used to help decrease infection and assist with wound care [ 1617 ].

Trauma Scoring Systems – Trauma – Orthobullets

Three patients had not reported for follow-up and two patients had died before complete follow-up. A predictive salvage index. The Evidence-Based Orthopaedic Trauma Working Group performed a meta-analysis mangled extremity severity score observational studies on complex limb salvage or early amputation for severe extremitg injury.

Wound debridement, revascularization, and simple external fixation are all that can be done while a rapid turn for the worse should be anticipated.

Similarly there was a significant difference in the mean MESS score in the retrospective study, 4. The scores are summated to a maximum mangled extremity severity score Please fill out required fields. Enter your email address and we’ll send you a zeverity to reset your password. Borderline patients that stabilize after resuscitation can undergo early total care ETC.

Wheeless’ Textbook of Orthopaedics

If mangled extremity severity score need for amputation is not clear upon initial examination, then limb salvage should be attempted. In contrast, a larger study by Brown et al. Most of these predictive indices have been criticized as being too subjective, complex, and difficult to apply universally. Both the patient and surgeon must anticipate multiple subsequent operative procedures, a manglsd commitment to rehabilitation and a high probability of significant sequelae and functional limitations as an end result in these serious high injuries.

Others have criticized the subjectivity of the MESS, and review of larger series of patients has shown lower sensitivity of the index than mangled extremity severity score reported [ 2225 — 28 ].

Management of the mangled extremity

The records of 37 patients having sustained 43 open fractures or mangled upper extremity injuries, seen and treated at the University of New Mexico’s Regional Trauma Center between April and Septemberhave been reviewed. However, when the limbs which required delayed amputation were analyzed, the LSI was slightly more accurate in predicting amputation.

The validity of the mangled extremity severity score in the assessment of upper mangled extremity severity score injuries.