title: Mangled extremity--case report, literature review and borderline cases guidelines proposal.
abstract: Treatment of a mangled lower extremity represents a major challenge. The decision whether to amputate or attempt reconstruction is currently based upon surgical evaluation. The aim of this paper is to propose a new approach to surgical evaluation based on scoring systems, local clinical status of the patient as well as comorbidities, mechanism of trauma and hospital resources. Available literature regarding this topic was evaluated and a case of patient with mangled extremity is presented. Based on current literature guidelines and evidence-based medicine, management for borderline cases is proposed to aid clinical decision making in these situations. We describe a 44-year old male patient who presented with mangled lower left leg. Despite a borderline Mangled Extremity Severity Score (MESS), due to the overall health status of the patient and local clinical status with preserved plantar sensitivity and satisfactory capillary perfusion, reconstruction was attempted. After 6 months of treatment, all wounds healed completely with no pain, and satisfactory motor and sensory function was achieved. In conclusion, the treatment of mangled extremity treatment should be based on evidence based literature along with a clinical evaluation of every individual patient. Scores are helpful, but should not be taken as the sole indication for amputation.
authors: Karlovac General Hospital, Department of Traumatology, Karlovac, Croatia. borebakota@yahoo.com
authors: Bore
authors: B
authors: Bakota
authors: Mario
authors: M
authors: Kopljar
authors: Zoran
authors: Z
authors: Jurjević
authors: Mario
authors: M
authors: Staresinić
authors: Ivan
authors: I
authors: Cvjetko
authors: Ivan
authors: I
authors: Dobrić
authors: Diarmuid
authors: D
authors: De Faoite
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D018409:Foot Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D009985:Orthopedics / Q000592:standards*; D017410:Practice Guidelines as Topic; D011859:Radiography; D015599:Trauma Severity Indices