Are We Justified Doing Salvage or Amputation Procedure Based on Mangled Extremity Severity Score in Mangled Upper...

Area of Science:

• Trauma surgery
• Orthopedics
• Reconstructive surgery

Background:

• Mangled upper limb injuries are increasing due to accidents.
• Existing scoring systems for lower limbs are often extrapolated for upper limb injuries.
• Lack of specific scoring systems hinders decision-making for salvage versus amputation.

Observation:

• The study evaluated 10 mangled upper limb injury cases using the MESS and MESI scoring systems.
• Average MESS was 7.7, and average MESI was 18.1.
• Amputation was performed in 3 cases; salvage in 7. Salvage was prioritized unless life-threatening.

Findings:

• The MESS score threshold of >7 for amputation, typically used for lower limbs, was not consistently justified for upper limbs in this study.
• The MESI score showed greater reliability in predicting outcomes for mangled upper limb injuries compared to MESS.
• Functional outcomes, assessed by Visual Analog Scale and SF-36, were generally satisfactory, though elderly and diabetic patients reported lower satisfaction.

Implications:

• Upper and lower limb mangled injuries differ significantly due to vascularity and anatomy, necessitating distinct scoring systems.
• The MESI scoring system appears more reliable for upper limb injuries, warranting further large-scale prospective validation.
• Salvage should be the primary goal, considering factors like prosthesis cost and patient tolerance, as even a functional "woody limb" may be well-accepted.