*LIMB SALVAGE Vs AMPUTATION :
*To predict which limbs will be salvageable after trauma, available scoring systems include the predictive salvage index, the limb injury score, the limb salvage index, the mangled extremity syndrome index, and the mangled extremity severity score. Of these, the Mangled extremity severity score was found to be most useful.
*This system, which is easy to apply, grades the injury on the basis of the energy that caused the injury, limb ischemia, shock, and the patient's age.
*The system was subjected to retrospective and prospective studies, with a score of 6 or less consistent with a salvageable limb. With a score of 7 or greater, amputation was the eventual result.
*Although we do not strictly follow these guidelines in all patients, we do calculate and document a mangled extremity severity score in the chart whenever we are considering primary amputation versus a complicated limb salvage.
*To predict which limbs will be salvageable after trauma, available scoring systems include the predictive salvage index, the limb injury score, the limb salvage index, the mangled extremity syndrome index, and the mangled extremity severity score. Of these, the Mangled extremity severity score was found to be most useful.
*This system, which is easy to apply, grades the injury on the basis of the energy that caused the injury, limb ischemia, shock, and the patient's age.
*The system was subjected to retrospective and prospective studies, with a score of 6 or less consistent with a salvageable limb. With a score of 7 or greater, amputation was the eventual result.
*Although we do not strictly follow these guidelines in all patients, we do calculate and document a mangled extremity severity score in the chart whenever we are considering primary amputation versus a complicated limb salvage.
*Mangled Extremity Severity Score
| Type | Characteristics | Injuries | Points |
|---|---|---|---|
| 1 | Low energy | Stab wounds, simple closed fractures, small-caliber gunshot wounds | 1 |
| 2 | Medium energy | Open or multiple-level fractures, dislocations, moderate crush injuries | 2 |
| 3 | High energy | Shotgun blast (close range), high-velocity gunshot wounds | 3 |
| 4 | Massive crush | Logging, railroad, oil rig accidents | 4 |
| Shock Group | |||
| 1 | Normotensive hemodynamics | BP stable in field and in OR | 0 |
| 2 | Transiently hypotensive | BP unstable in field but responsive to intravenous fluids | 1 |
| 3 | Prolonged hypotension | Systolic BP <90 mm Hg in field and responsive to intravenous fluid only in OR | 2 |
| Ischemia Group | |||
| 1 | None | Pulsatile limb without signs of ischemia | 0[*] |
| 2 | Mild | Diminished pulses without signs of ischemia | 1[*] |
| 3 | Moderate | No pulse by Doppler, sluggish capillary refill, paresthesia, diminished motor activity | 2[*] |
| 4 | Advanced | Pulseless, cool, paralyzed, and numb without capillary refill | 3[*] |
| Age Group | |||
| 1 | <30 y | 0 | |
| 2 | >30 – <50 y | 1 | |
| 3 | >50 y | 2 | |
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