The Mangled Extremity Severity Score (MESS) does not predict amputation in popliteal artery injury

Abstract

Purpose Vascular injuries in lower extremity trauma, especially with involvement of the popliteal artery, are associated with considerably high rates of limb loss, especially with blunt trauma mechanisms. The aim of this study was to evaluate the risk of amputation in patients with traumatic popliteal artery lesions with special focus on the validity of the Mangled Extremity Severity Score (MESS). Methods In this retrospective study, all patients treated for isolated lesions of the popliteal artery following trauma between January 1990 and December 2020 at a high-volume level I trauma center were included. Primary outcome was limb salvage dependent on MESS and the influence of defined parameters on limb salvage was defined as secondary outcome. The extent of trauma was assessed by the MESS. Results A total of 50 patients (age 39.2 ± 18.6 years, 76% male) with most blunt injuries (n = 47, 94%) were included. None of the patients died within 30 days and revascularization was attempted in all patients with no primary amputation and the overall limb salvage rate was 88% (44 patients). A MESS ≥ 7 was observed in 28 patients (56%) with significantly higher rates of performed fasciotomies (92.9% vs. 59.1%; p < 0.01) in those patients. MESS did not predict delayed amputation within our patient cohort (MESS 8.4 ± 4.1 in the amputation group vs. 8.1 ± 3.8 in the limb salvage group; p = 0.765). Conclusion Revascularization of limbs with isolated popliteal artery injuries should always be attempted. MESS did not predict delayed amputation in our cohort with fasciotomy being an important measure to increase limb salvage rates.

Revisiting the Mangled Extremity Severity Score (MESS) in Popliteal Artery Injury: A Single-Centre Experience in Vietnam

“…Despite the usefulness of the MESS score, we concur with other authors that it requires revision [10,14]. Our study, as well as others, suggests that the predictive value of the MESS is limited.…”

Temporary arterial shunts in combat patient with vascular injuries to extremities wounded in Russian-Ukrainian war: A case report

“…Vein injury was not repaired. The Mangled Extremity Severity Score (MESS) showed 7 points for this case, indicating borderline risk for limb amputation [8] .…”

Investigating Weekend Effect in the Management of Upper and Lower Extremity Degloving Injuries

“…Additionally, we used MESS to characterize degloving injury severity, which has received criticism for poor correlations with limb salvage rates and mixed prediction of amputation risk based on injury type. [58][59][60][61] However, in combination with ISS, MESS may have higher predictive value for amputation, and both scores were considered in this study. 62 Additionally, injury severity informs choice of interventions; so it was important to balance injury severity across groups to examine true effects of weekend presentation on interventions and outcomes.…”