Can Mangled Extremity Scoring System (MESS) solve the mess of vascular trauma

• Main Authors: Shamayal Rabbani, Mohd Azam Haseen, Amjad Ali Rizwi, Mohd Hanif Beg
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Indian Journal of Vascular and Endovascular Surgery
• Subjects: femoropopliteal injury; mangled extremity severity score; vascular trauma
• Online Access: http://www.indjvascsurg.org/article.asp?issn=0972-0820;year=2020;volume=7;issue=1;spage=22;epage=28;aulast=
• ISSN: 0972-0820; 2394-0999

Introduction: Trauma is the new scourge of humankind as without utmost and urgent care, it can result in the loss of limb and life. Civilian trauma is mostly caused by road traffic accidents with resultant skeletal, vascular, and neurological injuries. Vascular injuries most commonly involve the extremities and occur in young males. Materials and Methods: Ours is prospective observational study, in which 50 patients of the lower limb vascular injury were included in the study. Results: All of them were male, and mostly, they were in the second and third decades of life. Popliteal artery was the most commonly injured vessel, and road traffic accident was the most common mode of injury. Fifty-six percent (n = 28) had favorable outcomes with 8% mortality (n = 4). Twenty-six (52%) patients had bony involvement, the most commonly injured bone was tibia (n = 16, 32%). The mean warm ischemia time was 15.56 ± 14.03 (range: 3–48) h. Mangled Extremity Severity Score (MESS) scores were significantly different in salvaged and nonsalvaged limbs (P = 0.004). The sensitivity and negative predictive value of MESS were very high (100%), but the specificity and positive predictive value for unfavorable outcomes were low (57.14% and 64.71%). Skeletal injury, neurological involvement, and a blunt mechanism of injury were found to have a significant association with an unfavorable outcome in the patients. Conclusion: We concluded that MESS cannot be completely relied on, and the surgeon's clinical assessment and experience are necessary to decide the plan of management. Warm ischemia time is not the most important factor affecting limb survival, and other factors such as neurological and bony involvement need to be considered. MESS helps to frame the data for the clinician and can help in counseling patients, and their families that poor outcomes are more likely when MESS score is high. Further, large-scale, multicenter randomized trials are necessary for the identification of other risk factors and their incorporation into scoring systems.