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Extreme horrendous lower appendages wounds have been related with high rate of different frameworks included. That is settle on trouble and weight on specialist's dynamic either to sever or protect the harmed appendages. the evaluation of seriousness of injury to the appendage is generally done dependent on abstract rules as opposed to target rules. The error of this strategy drove a few creators to endeavor to measure the seriousness of injury and to propose scores in order to build up mathematical rules .The Mangled Extremity Severity Score (MESS) is presumably the most widely recognized scoring framework utilized. Point revalidation of Mangled Extremity Severity Score (MESS) in lower appendage awful vascular injury. Techniques This is an imminent non randomized investigation, led on 33 patients with serious furthest points wounds that met the measures of the Mangled Extremity Severity Scoring (MESS score at or close to edge (score 7 and score 8) taking care of the Emergency Department (ED) at Benha University Hospital. Result this investigation showed that the most regular influenced vessel was popliteal supply route (54.5%) trailed by PTA (24.2%) at that point ATA and SFA (18.2% for each) and CFA (3.0%) This examination showed that 54.5% showed breaks, 21.2% showed disengagement, 18.2% showed nerve injury and 42.4% showed muscle injury, Mean length of emergency clinic stay was 10 days with standard deviation of 3 days, just 27.3% of study populace went through 2ry removal. Ends the MESS was not prescient of removal Overall with the need of additional revalidation and the chance of appendage rescue for MESS score over the edge in the present of new period in remaking methods.

Background: Staple line bleeding & leak are the most annoying events of Laparoscopic Sleeve Gastrectomy. Staple line reinforcement (SLR) is considered a weapon to reduce the incidence of such dangerous events. Purpose: Rationale of this study is to compare between non reinforced and reinforced staple line with vicryl sutures during laparoscopic sleeve gastrectomy. Patients and methods: Patients were divided into two groups; group (A); 25 cases; underwent Laparoscopic Sleeve Gastrectomy (LSG) with strengthening of the stapler line by v-lock suture and group (B); 25 cases; underwent LSG without reinforcement of stapler line. patient follow-up period was 12 months. Results: There were no significant differences between both groups as regard to patient demographic data and hospital stay. Group (A) was performed in longer time; 102 ± 9 vs 74 ± 4 in group (B). frequency of bleeding was more in group (B); 7 patients (28%) than in group (A); one patient (4%). Also frequency of leakage was more group (B); 6 patients (24%) than in group (A); no patients (0%). P-value was for bleeding and leakage; 0.049 & 0.022. Conclusions: Sleeve gastrectomy by laparoscopy is a safe, minimally invasive and easy operative procedure. Adding reinforcement of the whole staple line is easy method to reduce the rate and severity of the postoperative bleeding and leakage to a great extent. Additional cost due to invaginating the whole staple line may be counterbalanced by the reduction in the length of hospital stay.

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