Trauma: Mangled Extremity

Definition

• Definition: Damage to ≥ 3 Functional Components
• Functional Components:
  • Soft Tissue
  • Nerves
  • Vessels
  • Bones

Mangled Extremity Severity Score (MESS)

• Factors:
  • Tissue Injury:
    • 1 – Low Energy (Stab, Simple Fracture or Pistol Gun Shot Wound)
    • 2 – Medium Energy (Open Fracture, Multiple Fractures or Dislocation)
    • 3 – High Energy (High-Speed MVC or Rifle Gun Shot Wound)
    • 4 – Very High Energy (High Energy & Gross Contamination)
  • Ischemia Time:
    • 1 – Pulse Reduced or Absent but Perfusion Normal
    • 2 – Pulseless, Paresthesia, Diminished Capillary Refill
    • 3 – Cool, Paralyzed, Insensate, Numb
  • Shock:
    • 0 – SBP Always > 90 mmHg
    • 1 – SBP Transiently < 90 mmHg
    • 2 – SBP Persistently < 90 mmHg
  • Age (Years):
    • 0 – < 30
    • 1 – 30-50
    • 2 – > 50
  • *Score Doubled if Ischemia Time > 6 Hours
• Used to Consider Amputation vs Salvage
  • Score 0-6 Points – Limb Will Likely Be Salvaged
  • Score 7-14 Points – Amputation Will Likely Be Required