The Mangled Extremity Severity Score Fails to be a Good Predictor for Secondary Limb Amputation After Trauma with Vascular Injury in Central Europe

  • Gloria Maria HohenbergerEmail author
  • Peter Konstantiniuk
  • Janos Cambiaso-Daniel
  • Veronika Matzi
  • Angelika Maria Schwarz
  • David Benjamin Lumenta
  • Tina Ulrike Cohnert
Original Scientific Report



The Mangled Extremity Severity Score (MESS) was constructed as an objective quantification criterion for limb trauma. A MESS of or greater than 7 was proposed as a cut-off point for primary limb amputation. Opinions concerning the predictive value of the MESS vary broadly in the literature. The aim of this study was to evaluate the applicability of the MESS in a contemporary civilian Central European cohort.


All patients treated for extremity injuries with arterial reconstruction at two centres between January 2005 and December 2014 were assessed. The MESS and the amputation rate were determined.


Seventy-one patients met the inclusion criteria and could be evaluated for trauma mechanism and injury patterns. The mean MESS was 4.97 (CI 4.4–5.6). Seventy-three per cent of all patients (52/71) had a MESS < 7 and 27% (19/71) of ≥7. Eight patients (11%) underwent secondary amputation. Patients with a MESS ≥ 7 showed a higher, but statistically not significant secondary amputation rate (21.1%; 4/19) than those with a MESS < 7 (7.7%; 4/52; p = 0.20). The area under the ROC curve was 0.57 (95% CI 0.41; 0.73).


Based on these results, the MESS appears to be an inappropriate predictor for amputation in civilian settings in Central Europe possibly due to therapeutic advances in the treatment of orthopaedic, vascular, neurologic and soft-tissue traumas.



The study was not supported by any funding sources.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical details

This study was approved by the local Ethics Committee (27-460 ex 14/15) in accordance with the principles of the Declaration of Helsinki and the ICH-GCP Guidelines.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Gloria Maria Hohenberger
    • 1
    Email author
  • Peter Konstantiniuk
    • 2
  • Janos Cambiaso-Daniel
    • 3
  • Veronika Matzi
    • 4
  • Angelika Maria Schwarz
    • 5
  • David Benjamin Lumenta
    • 3
  • Tina Ulrike Cohnert
    • 2
  1. 1.Department of Orthopaedics and TraumaMedical University of GrazGrazAustria
  2. 2.Division of Vascular Surgery, Department of SurgeryMedical University of GrazGrazAustria
  3. 3.Division of Plastic, Aesthetic and Reconstructive Surgery, Department of SurgeryMedical University of GrazGrazAustria
  4. 4.Department of SurgeryState Hospital LeobenLeobenAustria
  5. 5.AUVA Trauma Hospital GrazGrazAustria

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