[Therapeutic approach in vascular injuries of the lower extremity: Amputation or limb salvage].
The management of lower extremity trauma with vasculary involvement should be directed toward to the salvage of the extremity or to the primary amputation according to the additional pathologies, parameters of the patient and the extremity. We investigated the efficiency of Mangled Extremity Severity Score (MESS) system which is proposed as an grading system to evaluate the change to extremity salvage or the risk for onset of systemic complications. 81 patients with lower extremity trauma were analyzed according to MESS criteria. 79 of the patients were men and mean age was 23 +/- 4. Fourteen patients had higher MESS score. (MESS > 7). Seven of them were older than 50 years. Primary amputation was performed in four of these 7 patients. Vascular repair was performed in three of patients. Multiorgan failure was developed in two of them and both patients died. Secondary amputation was performed to another patients underwent vasculary repair who had MESS > 7 score. Primary amputation was not performed directly in young patients who had MESS > 7. Secondary amputation was required in two of these patients. MESS scoring system can easily predict amputation in older patients but may cause unnecessary amputation in young patients.
Ozal
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Gülhane Askeri Tip Akademisi, Kalp ve Damar Cerrahisi, 06018 Etlik, Ankara. ozals@tr.net
Us
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Bingöl
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Oz
B S
BS
Kuralay
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E
Tatar
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H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply* / Q000601:surgery*; D007869:Leg Injuries / Q000473:pathology* / Q000601:surgery*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015599:Trauma Severity Indices