Primary amputation vs limb salvage in mangled extremity: a systematic review of the current scoring system

Area of Science:

• Orthopedic Surgery
• Trauma Management
• Reconstructive Surgery

Background:

• Mangled lower extremity injuries present significant reconstructive challenges.
• Failed limb salvage attempts carry a high risk of patient mortality.
• Existing scoring systems lack consensus on reliability for guiding amputation decisions.

Purpose of the Study:

• To review and evaluate commonly used scoring systems for mangled lower extremities.
• To assess the reliability and accuracy of scores like MESS, PSI, LSI, and NISSSA.

Main Methods:

• Systematic literature search of PubMed, Cochrane, Scopus, and Web of Science.
• Inclusion of studies on mangled lower extremities with specific score reporting (MESS, PSI, LSI, NISSSA).
• Criteria included English language, last 30 years, minimum 15 cases, and 1-year follow-up.

Main Results:

• The Musculoskeletal Injury Severity Score (MESS) is the most frequently cited.
• MESS appears more accurate than the Limb Salvage Index (LSI) for predicting limb salvage.
• The Pressure-Sensitive Insole (PSI) score shows high sensitivity for successful limb salvage; NISSSA has low sensitivity/specificity. Limited data exists for pediatric mangled lower extremities, though scores show higher accuracy in children.

Conclusions:

• Scoring systems are adjuncts, not sole criteria, for amputation decisions in mangled lower extremities.
• These scores do not predict functional recovery post-limb salvage.
• Over-reliance on new techniques without considering score-based evidence can increase morbidity and mortality.