Limb salvage in a child with severely injured mangled lower extremity and muscle rigor

Elsharawy, Mohamed A.; Maher, Karay; Elsaid, Aymen

doi:10.1258/vasc.2012.cr0279

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…There is a lot of controversy in literature about the use of this scale. Elsharawy et al [ 12 ] in his prospective study considered 46 upper and lower extremities and described, considering MESS injuries scoring higher than 7 and only secondary amputation, a MESS score specificity of 27.5 %. Menakuru [ 13 ] in his study confirmed the results obtained by Elsharawy et al He was able to save the limb in 20 (69 %) of 29 patients with MESS higher than 7.…”

Section: Resultsmentioning

confidence: 99%

“…In Authors opinion it is better, at first time, to try limb salvage in children also in presence of high severity score. Elsharawy et al [ 12 ] described a case of limb salvage in a child with clinical picture of irreversible ischemia and high mangled severity scores. They recommended trying to revascularize and to save the limb in children, regardless clinical condition and severity scores.…”

Section: Discussionmentioning

confidence: 99%

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Primary amputation vs limb salvage in mangled extremity: a systematic review of the current scoring system

Schirò

Sessa

Piccioli

et al. 2015

BMC Musculoskelet Disord

112

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BackgroundIn the last decades a lot of new reconstructive techniques were developed for the treatment of mangled lower extremity. However failed attempt to limb salvage is related to high risk of mortality for the patient. Several scores were developed to establish guidelines for the decision to amputate or not, however in literature there is no consensus about the reliability of this scores.MethodsThe authors focused their attention on the most used score system to provide guidance of the management of a mangled lower limb. The search term used included mangled lower extremity, MESS, PSI, LSI and NISSSA. The inclusion criteria were: studies dealing with mangled lower extremity; articles reporting MESS, PSI, LSI or NISSSA scores; articles published in English in PubMed, Cochrane, Scopus and web of science in the last 30 years, minimum number of cases in study of 15, minimum follow up of 1 year.ResultsAccording with the criteria described above, we found 134 articles in PubMed, 165 articles in Scopus, 111 articles in the Cochrane Library and 108 articles in Web of Science. The most used score in literature is the MESS. Few results are shown using the other severity scores. There are a lot of controversies in literature about the use of this scale. MESS seems to be more accurate than the LSI in prediction of limb salvage. LSI score shows better results when applied to type III tibial fractures. High sentivity of the PSI score is described when applied to predict successful limb salvage. Low sensitivity and specificity are described for the NISSSA score. The literature is very poor of articles related to mangled lower extremity in children. Higher sensitivity and specificity are described for these scores in children when compared to adult population.ConclusionThe mangled lower extremity treatment is a challenge for the surgeon. Many scores were developed to help the surgeon, however they cannot be used as the sole criterion by which amputation decision are made and, in case of succesful limb salvage, they are not predictive of the functional recovery. Moreover, undue enthusiasm for new surgical techniques can lead to increased morbidity and mortality in case of secondary amputation.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Primary amputation vs limb salvage in mangled extremity: a systematic review of the current scoring system

Schirò

Sessa

Piccioli

et al. 2015

BMC Musculoskelet Disord

112

View full text Add to dashboard Cite

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“…Reconstruction is the first consideration if the patient is young: high rates of limb salvage and function can be expected in pediatric patients, 11 therefore reconstruction is indicated even in severe injury. 12,13 Reconstruction is also favored in adults if plantar sensation is intact. 13,14 Bosse et al showed that patients may regain plantar sensation after reconstruction despite lack of sensation at the time of surgery, 15 which suggests that reconstruction may also be attempted in patients who have the possibility of regaining sensation, i.e., those with likely neuropraxia rather than avulsion or complete transection of the nerve.…”

Section: Situations In Which Reconstruction Is Favoredmentioning

confidence: 99%

“…1 summarizes injury characteristics that surgeons must assess and consider in making their decision to reconstruct. [12][13][14][15][16][17][18][19][20] In lower extremity trauma reconstruction, the surgeon must consider all options on the reconstructive ladder, or more recently elevator, to provide the patient with optimum function. 13,21 However, the lower rungs of the ladder, such as primary closure or skin grafting, are often inadequate in the setting of lower extremity trauma due to vast tissue deficits and Fig.…”

Section: Situations In Which Reconstruction Is Favoredmentioning

confidence: 99%

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Amputations versus Salvage: Reconciling the Differences

Black

Ormiston

Fan

et al. 2019

J Reconstr Microsurg

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Background There are many factors to consider when choosing between amputations versus salvage in lower extremity reconstructive surgery. Postoperative functionality and survival benefit are critical factors when deciding between limb salvage and amputation. Methods In this review, we present the evidence and the risks and benefits between these two options in the setting of the acute, trauma population and the chronic, diabetes population. Results The trauma population is on average young without significant comorbidities and with robust vasculature and core strength for recovery. Therefore, these patients can often recover significant function with anamputation and prosthesis. Amputation can therefore be the more desirable in this patient population, especially in the case of complete traumatic disruption, unstable patients, high risk of extensive infection, and significant nerve injury. However, traumatic lower extremity reconstruction is also a viable option, especially in the case of young patients and those with intact plantar sensation and sufficient available tissue coverage. The diabetic population with lower extremity insult has on average a higher comorbidity profile and often lower core strength. These patients therefore often benefit most from reconstruction to preserve limb length and improve survival. However, amputation may be favored for diabetics that have no blood flow to the lower extremity, recalcitrant infection, high-risk comorbidities that preclude multiple operations, and those with end stage renal disease. Conclusion Many patient-specific factors should be considered when deciding between amputation vs. salvage in the lower extremity reconstruction population.

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