Application of the Mangled Extremity Severity Score in a Combat Setting

Kjorstad, Randy; Starnes, Benjamin W.; Arrington, Edward D.; Devine, John; Andersen, Charles A.; Rush, Robert M.

doi:10.7205/milmed.172.7.777

Cited by 63 publications

(18 citation statements)

References 17 publications

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“…These techniques may influence edema control, hospital stay, and time to prosthetic fitting, which were all key identified outcome measures in the studies within this section. Using accepted measurements to determine the level of viable tissue prior to amputation can lead to improved outcomes [70][71]. Safety incidents that are known to occur in people with lower-limb amputation during inpatient rehabilitation, such as falls and re-injury, were also not counted in these studies [72].…”

Section: Postoperative Carementioning

confidence: 99%

Prosthetic interventions for people with transtibial amputation: Systematic review and meta-analysis of high-quality prospective literature and systematic reviews

Highsmith¹,

Kahle

Miro

et al. 2016

J Rehabil Res Dev

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Abstract-Considering transtibial amputation (TTA) rehabilitation costs and complexity, high-quality literature should inform clinical practice. Systematic reviews (SRs) suggest this is not the case. This article's purpose was to review the highest-quality evidence available to guide clinical practice for TTA regarding five prosthetic intervention areas. Six databases were searched for high-quality SRs and prospective clinical trials (randomized clinical trials [RCTs]). Reviewers screened, sorted, rated (i.e., methodologic quality, bias risk), and extracted article data. Meta-analyses were conducted when possible. Thirty-one references were included (25 RCTs and 6 SRs). Five topical areas emerged (alignment, feet and ankles, interface, postoperative care, pylons). Twenty-three evidence statements were supported by level 2 evidence and eight by level 1 evidence. All RCTs reported randomization and reasonable data presentation. Concealed allocation and blinding were not widely used. Mean attrition was 11%. SRs included no meta-analyses. Functional level was poorly reported. Grouping feet and ankle components by functional classification enabled meta-analyses, though variance was considerable given the small sample sizes. Prosthetic interventions are generally safe for TTAs. High-quality literature enabled formulation of evidence statements to support select clinical practice areas, though quantity was lacking. Thus, numerous topics related to TTA care lack rigorous evidence. Although blinding in prosthetic research requires increased funding and effort, it could greatly improve the methodologic quality of prosthetic research.Abbreviations: CI = confidence interval, ESAR = energy storing and release, EWA = early walking aid, FK = flexible keel, GRF = ground reaction force, MA = multi-axial, NIH = National Institutes of Health, PEDro = Physiotherapy Evidence Database Scale, PTB = patella tendon bearing, RRD = rigid removable dressing, SA = single axis, SACH = solid ankle cushion heel, SIGN = Scottish Intercollegiate Guidelines Network, SR = systematic review, TSB = total surface bearing, TTA = transtibial amputation, VASS = vacuum-assisted suspension system, vGRF = vertical ground reaction force, VSP = vertical shock pylon.

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Section: Postoperative Carementioning

confidence: 99%

Prosthetic interventions for people with transtibial amputation: Systematic review and meta-analysis of high-quality prospective literature and systematic reviews

Highsmith¹,

Kahle

Miro

et al. 2016

J Rehabil Res Dev

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“…Falls from a height, high-velocity gunshots, and explosion injuries constitute the remainder of mechanisms [8]. Increasingly a specific subgroup being described is based on combat (blast) injuries sustained in the Middle East [1]. The most significant factor involved with the injury mechanism is the amount of energy transferred to the extremity rather than the actual mechanism.…”

Section: Mechanism Of Injurymentioning

confidence: 99%

“…Following this, any radiographic studies may be obtained (including vascular studies if necessary), and intravenous antibiotic and tetanus prophylaxis administered. A Mangled Extremity Severity Score (MESS) is calculated for each patient at the onset of treatment [1]. If an early amputation is deemed necessary it is often advantageous to take medical record photographs to document the severity of the injury.…”

Section: Initial Managementmentioning

confidence: 99%

“…The proposed advantages of this predictive index are that the information is readily available upon presentation, its relative simplicity, and reproducibility. Rush et al [1] showed in a combat setting the MESS was a sensitive predictor of amputation. In contrast, a larger study by Brown et al [8] in British military patients (Iraq and Afghanistan conflicts) with mangled extremity ballistic injuries found that the MESS did not help decide whether or not an amputation was appropriate.…”

Section: Scoring Systemsmentioning

confidence: 99%

“…Advances in evacuation, resuscitation, wound care, free tissue transfer, and internal fixation make it nowadays possible to salvage limbs that would have been amputated in the past. Experience based on these injuries from a combat setting in World War II, the Korean and Vietnam War, and more recently in the Middle East (Operation Enduring Freedom and Operation Iraqi Freedom) has shown clearly progress with amputation rates for mangled extremities is decreasing from 72 to 13–20 % to less than 10 %, respectively [1]. Despite these technical advances, the management of a mangled extremity remains a very difficult decision process for the patient, his/her family, and the treating surgical team.…”

Section: Introductionmentioning

confidence: 99%

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Management of the mangled extremity

Prasarn¹,

Helfet²,

Kloen³

2012

Strategies in Trauma and Limb Reconstruction

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The management of a mangled extremity continues to be a matter of debate. With modern advances in trauma resuscitation, microvascular tissue transfer, and fracture fixation, severe traumatic extremity injuries that would historically have been amputated are often salvaged. Even if preserving a mangled limb is a technical possibility, the question is often raised whether the end result will also be functional and what treatment would lead to the best patient outcome. The road to salvage is often prolonged with significant morbidity, reoperations, financial costs, and even mortality in some instances. Numerous factors have been implicated in the outcome of these injuries, and a number of scoring systems have been designed in an attempt to help guide the treating surgeon in the acute phase. However, much controversy remains on the ability of these grading systems to predict successful salvage of the mangled extremity. In this review, we discuss the mechanisms of injury, various available scoring systems, initial management, outcome and specific differences between lower and upper extremity trauma injuries.

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Lower Extremity Reconstruction Following Trauma and Tumors

Wallace

Wei

2010

Plastic and Reconstructive Surgery

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Application of the Mangled Extremity Severity Score in a Combat Setting

Cited by 63 publications

References 17 publications

Prosthetic interventions for people with transtibial amputation: Systematic review and meta-analysis of high-quality prospective literature and systematic reviews

Prosthetic interventions for people with transtibial amputation: Systematic review and meta-analysis of high-quality prospective literature and systematic reviews

Management of the mangled extremity

Lower Extremity Reconstruction Following Trauma and Tumors

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