Patient comes with crush injury to upper limb, doctor is concerned about gangrene and sepsis what can help decide between amputation and limb salvage?
Mangled Extremity Severity Score (MESS) used as predictor of eventual amputation versus limb salvage in crushing injuries. Higher the score lower the chances of salvage. Type Points (Depending on severity) Shock group 0-2 Ischemia group 1-4 Velocity of trauma 1-4 Age group 0-1 Total score 11 Mess Score: Total Score is 11, six or less consistent with a salvageable limb. Seven or greater amputation is generally the eventual result. Crush syndrome Limb is compressed for a prolonged period and after extended use of pneumatic antishock garment resulting in hypoperfusion and myonecrosis in the crushed limb. When the limb is released from the compression, toxic metabolites get released to cause reperfusion injury. Can result in a systemic reaction due to tissue necrosis. Free myoglobin can lead to acute tubular necrosis and renal failure. Myonecrosis can lead to metabolic acidosis with hyperkalaemia and hypocalcaemia.
MESS
GCS score
Gustilo-Anderson classification
ASIA guidelines
Amputations and Spos Injury