Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fox CJ, Gillespie DL, O’Donnell SD et al (2005) Contemporary management of wartime vascular trauma. J Vasc Surg 41:638–644

    Article  Google Scholar 

  2. Doody O, Given MF, Lyon SM (2008) Extremities—indications and techniques for treatment of extremity vascular injuries. Injury 39:1295–1303

    Article  CAS  Google Scholar 

  3. Menakuru SR, Behera A, Jindal R et al (2005) Extremity vascular trauma in civilian population: a seven-year review from North India. Injury 36:400–406

    Article  Google Scholar 

  4. Rasouli MR, Moini M, Khaji A (2009) Civilian traumatic vascular injuries of the upper extremity: report of the Iranian national trauma project. Ann Thorac Cardiovasc Surg 15:389–393

    PubMed  Google Scholar 

  5. Johansen K, Daines M, Howey T et al (1990) Objective criteria accurately predict amputation following lower extremity trauma. J Trauma 30:568–572 (discussion 572–573)

    Article  CAS  Google Scholar 

  6. Korompilias AV, Beris AE, Lykissas MG et al (2009) The mangled extremity and attempt for limb salvage. J Orthop Surg Res 4:4

    Article  Google Scholar 

  7. Prasarn ML, Helfet DL, Kloen P (2012) Management of the mangled extremity. Strateg Trauma Limb Reconstr 7:57–66

    Article  Google Scholar 

  8. Bernstein ML, Chung KC (2007) Early management of the mangled upper extremity. Injury 8(Suppl 5):S3–S7

    Article  Google Scholar 

  9. Mommsen P, Zeckey C, Hildebrand F et al (2010) Traumatic extremity arterial injury in children: epidemiology, diagnostics, treatment and prognostic value of Mangled Extremity Severity Score. J Orthop Surg Res 5:25

    Article  Google Scholar 

  10. Prichayudh S, Verananvattna A, Sriussadaporn S et al (2009) Management of upper extremity vascular injury: outcome related to the Mangled Extremity Severity Score. World J Surg 33:857–863. https://doi.org/10.1007/s00268-008-9902-4

    Article  PubMed  Google Scholar 

  11. Rush RM Jr, Kjorstad R, Starnes BW et al (2007) Application of the Mangled Extremity Severity Score in a combat setting. Mil Med 172:777–781

    Article  Google Scholar 

  12. Sharma S, Devgan A, Marya KM et al (2003) Critical evaluation of mangled extremity severity scoring system in Indian patients. Injury 34:493–496

    Article  Google Scholar 

  13. Brown KV, Ramasamy A, McLeod J et al (2009) Predicting the need for early amputation in ballistic mangled extremity injuries. J Trauma 66:S93–S97 (discussion S97–S98)

    Article  Google Scholar 

  14. Johansen K, Hansen ST Jr (2015) MESS (Mangled Extremity Severity Score) 25 years on: time for a reboot? J Trauma Acute Care Surg 79:495–496

    Article  Google Scholar 

  15. Tscherne H (1997) Polytrauma management, 1st edn. Springer, Heidelberg

    Google Scholar 

  16. Perkins ZB, Yet B, Glasgow S (2015) Meta-analysis of prognostic factors for amputation following surgical repair of lower extremity vascular trauma. Br J Surg 102:436–450

    Article  CAS  Google Scholar 

  17. Barla M, Gavanier B, Mangin M et al (2017) Is amputation a viable treatment option in lower extremity trauma? Orthop Traumatol Surg Res 103:971–975

    Article  CAS  Google Scholar 

  18. Loja MN, Sammann A, DuBose J (2017) The mangled extremity score and amputation: time for a revision. J Trauma Acute Care Surg 82:518–523

    Article  Google Scholar 

  19. Melcer T, Sechriest VF, Wlaker J et al (2013) A comparison of health outcomes for combat amputee and limb salvage patients injured in Iraq and Afghanistan wars. J Trauma Acute Care Surg 75:S247–S254

    Article  Google Scholar 

  20. Tennent DJ, Wenke JC, Rivera JC (2014) Characterisation and outcomes of upper extremity amputations. Injury 45:965–969

    Article  Google Scholar 

  21. Miller EA, Iannuzzi NP, Kennedy SA (2018) Management of the mangled upper extremity: a critical analysis review. JBJS Rev 6:e11

    Article  Google Scholar 

  22. Polonet D, Rose MI, Brown DJ (2017) Amputation versus limb salvage of the lower extremity. In: Elkwood A, Kaufman M, Schneider L (eds) Rehabilitative surgery. Springer, Cham, pp 217–232

    Chapter  Google Scholar 

  23. van Dongen TT, Huizinga EP, de Kruijff LG (2017) Amputation: not a failure for severe lower extremity combat injury. Injury 48:371–377

    Article  Google Scholar 

Download references

Funding

The study was not supported by any funding sources.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria

    Gloria Maria Hohenberger

  2. Division of Vascular Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036, Graz, Austria

    Peter Konstantiniuk & Tina Ulrike Cohnert

  3. Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036, Graz, Austria

    Janos Cambiaso-Daniel & David Benjamin Lumenta

  4. Department of Surgery, State Hospital Leoben, Vordernberger Straße 42, 8700, Leoben, Austria

    Veronika Matzi

  5. AUVA Trauma Hospital Graz, Göstinger Straße 24, 8020, Graz, Austria

    Angelika Maria Schwarz

Authors
  1. Gloria Maria Hohenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Konstantiniuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Janos Cambiaso-Daniel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Veronika Matzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Angelika Maria Schwarz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David Benjamin Lumenta
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tina Ulrike Cohnert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gloria Maria Hohenberger.

Ethics declarations

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hohenberger, G.M., Konstantiniuk, P., Cambiaso-Daniel, J. et al. The Mangled Extremity Severity Score Fails to be a Good Predictor for Secondary Limb Amputation After Trauma with Vascular Injury in Central Europe. World J Surg 44, 773–779 (2020). https://doi.org/10.1007/s00268-019-05263-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-019-05263-w

Search

Navigation