Mangled Extremity Severity Score in the Assessment of Extremity Injuries - Is it Reliable?

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Abstract

[Indexed for MEDLINE] 3. Eur J Trauma Emerg Surg. 2023 Dec;49(6):2363-2371. doi: 10.1007/s00068-022-02179-4. Epub 2022 Nov 30. The Mangled Extremity Severity Score (MESS) does not predict amputation in popliteal artery injury. Gratl A(1), Kluckner M(2), Gruber L(3), Klocker J(1), Wipper S(1), Enzmann FK(1). Author information: (1)Department of Vascular Surgery, Medical University Innsbruck, University Hospital of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria. (2)Department of Vascular Surgery, Medical University Innsbruck, University Hospital of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria. Michaela.kluckner@i-med.ac.at. (3)Department of Radiology, Medical University Innsbruck, University Hospital of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria. PURPOSE: Vascular injuries in lower extremity trauma, especially with involvement of the popliteal artery, are associated with considerably high rates of limb loss, especially with blunt trauma mechanisms. The aim of this study was to evaluate the risk of amputation in patients with traumatic popliteal artery lesions with special focus on the validity of the Mangled Extremity Severity Score (MESS). METHODS: In this retrospective study, all patients treated for isolated lesions of the popliteal artery following trauma between January 1990 and December 2020 at a high-volume level I trauma center were included. Primary outcome was limb salvage dependent on MESS and the influence of defined parameters on limb salvage was defined as secondary outcome. The extent of trauma was assessed by the MESS. RESULTS: A total of 50 patients (age 39.2 ± 18.6 years, 76% male) with most blunt injuries (n = 47, 94%) were included. None of the patients died within 30 days and revascularization was attempted in all patients with no primary amputation and the overall limb salvage rate was 88% (44 patients). A MESS ≥ 7 was observed in 28 patients (56%) with significantly higher rates of performed fasciotomies (92.9% vs. 59.1%; p