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 . Mangled Extremity Severity Score (MESS). Introduction. used to predict necessity of amputation after lower extremity trauma. Variables. skeletal. fractures, soft tissue damage, vascular, nerve and tendon lesions. The Mangled Extremity Severity Score (MESS) is probably the most common scoring system.

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The MESS utilizes variables that can be readily obtained without extensive and complicated measurements or calculations. LSI was formulated based on the degree of injury to the arterial, nerve, bone, muscle, skin, venous and warm ischemia time. Once the general condition of the patient was stabilized, a detailed case history was recorded with particular importance to mode of injury, treatment taken if any, interval between injury and admission and associated medical or surgical illnesses if any.

Journal of Trauma, The principal investigators of the study request that you use xetremity official version of the modified score here.

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.

Massive lower extremity trauma, in particular open tibial fractures with associated vascular injuries, presents immediate and complex decision-making challenges between a limb salvage sevfrity and primary amputation.

Trauma Scoring Systems

A successful salvage limb was defined as an extremity that remained in the limb salvage and reconstruction pathway six months after injury. They also reported a prospective trial validating by index with 26 patients at a separate trauma center. A critical evaluation of mangled extremity severity score system in severely traumatized lower limbs.


In India, Sharma et al. Table 1 Mangled extremity severity score 4. This salvage protocol was abandoned if the general condition of the patient deteriorated or once the severe infection of injured limb was observed or renal failure set in making amputation inevitable. Results of both these studies suggest that many limbs with MESS score of equal to or more than 7 may be salvaged.

Bleeding Risk in Atrial Fibrillation: Score taken at hospital admission. Mangled lower extremity, Mangled extremity severity score, salvage versus amputation.

The appropriate contemporary lower extremity threshold value we avoid the term “cut-off”!! Similarly there was a significant difference in the mean MESS score in the retrospective study, 4. Trauma victims require management of significant craniocerebral, thoracic, abdominal, and pelvic injuries prior to consideration of limb salvage. Pulseless, paresthesias, slow capillary refill.

The purpose of the present study was to evaluate the clinical utility of Mangled extremity severity score MESS in severely injured lower limbs.

Hansen 2 in analyzing his vast personal experience with managing open fractures, noted that scroe limb salvage attempts may destroy a person physically, psychologically, socially and financially, with adverse consequences for the entire family as well. Open tibial fractures with associated vascular injuries: The mean scpre for salvaged limbs was 4.

Upper extremities are profoundly more important functionally than lower extremities are; upper extremity prostheses are much more primitive and less functional than lower extremity prostheses. The functional outcome of lower extremity fractures with vascular injury. What influence do you think more recent advances in surgical techniques and technology have had on the performance of the MESS? 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.

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Both the zeverity and surgeon must anticipate multiple subsequent operative procedures, a long-term commitment to rehabilitation and a high probability of manvled sequelae and functional limitations as an end result in these serious high injuries.

This experience reflected recent observations from other trauma centers e. The present study comprised 58 patients with 61 injured lower limbs.

Mangled Extremity Severity Score (MESS Score) – MDCalc

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. Was there a clinical experience that inspired you to create this tool for clinicians?

Patients were shifted to the operation room and initial management of the mangled extremity was started in the form of thorough irrigation with copious normal saline, meticulous debridement, pressure bandage, antibiotics and fracture stabilization with external fixator.

The MESS can potentially identify at time of initial evaluation patients who are candidates for successful limb salvage vs future amputation.

Table 3 Comparison of results with other studies. The analysis did not validate the clinical utility of any of the scoring systems. Child Pugh Score Severith severity of cirrhosis. How important is this topic for clinical practice? Formula Addition of the assigned points; if there has been limb ischemia for more than 6 hours, the “limb ischemia” points are doubled.

Badole, Department extermity Orthopedics and Traumatology, M. 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.