Vascular Trauma in the Extremities: Factors Associated with the Outcome and Assessment of Amputation Indexes.

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Abstract

20. Mil Med. 2007 Jul;172(7):777-81. doi: 10.7205/milmed.172.7.777. Application of the Mangled Extremity Severity Score in a combat setting. Rush RM Jr(1), Kjorstad R, Starnes BW, Arrington E, Devine JD, Andersen CA. Author information: (1)Department of Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA. OBJECTIVE: The aim of this study was to examine the Mangled Extremity Severity Score (MESS) in a combat setting. METHODS: Data on extremity injuries were collected from a forward surgical team. MESS and Revised Trauma Score values were retrospectively calculated for each patient. Student's t test was used to compare amputated and salvaged limbs. RESULTS: A total of 60 extremities was identified in 49 patients. There were 10 major vascular repairs (20%). MESS values differed significantly for the eight amputations performed (mean MESS, 7.87 +/- 1.91) and 50 salvaged extremities (mean MESS, 2.44 +/-_ 0.438; p = 0.001). CONCLUSIONS: A MESS of >7 correlated with amputation, thus validating the MESS in a combat setting. A young average patient age and high-energy injury mechanism on the battlefield leave ischemic time and shock as the most important factors in dictating whether a MESS is >7 or