Predicting the Need for Early Amputation in Ballistic Mangled Extremity Injuries

Abstract

The management of ballistic extremity injuries in military patients should be considered separate to that of civilians with high-energy trauma extremity injuries. The authors have identified important factors in the management, in particular the need for early amputation, of the military mangled extremity.

Medium-term outcomes following limb salvage for severe open tibia fracture are similar to trans-tibial amputation

“…At least six scoring systems have previously been proposed to quantify limb injury and assist surgeons in deciding which limbs are viable and which require amputation [14][15][16][17][18][19]. Not only have these systems been shown to be poor predictors of viability in both the civilian [20] and military context [21], but they focus on could a limb be salvaged technically as opposed to should a limb be salvaged in terms of enabling a superior outcome to be achieved for the patient.…”

Reconstruction of the Popliteal Vasculature After a Close-Range Shotgun Injury: Case Report

“…We always perform MESS scoring (Mangled Extremity Severity Scoring) to all patients with an upper or lower extremity injury. 6 This scoring system enables us to predict the possibility of amputation or the chance for salvage. Scoring also serves as a warning remark in a common language between the patient's family and the surgeon.…”

Traumatic amputations

“…The presence of a vascular injury that required repair in a physiologically unstable patient were the main factors in patients who required an amputation in one study. 21 This is unsurprising when considering the prolonged time needed for revascularisation, which will not be tolerated in a patient who is critically unwell.…”