Management of Upper Extremity Vascular Injury: Outcome Related to the Mangled Extremity Severity Score

Abstract

MESS, an outcome score used to grade the severity of extremity injuries, correlates well with the risk of amputation. Nevertheless, a MESS of >or=7 does not always mandate amputation. On the other hand, the MESS is a better predictor for patients who do not require amputation when the score is <7. The decisions to amputate in patients should be made individually based on clinical signs and an intraoperative finding of irreversible limb ischemia.

Salvaging a Crush Avulsed Ischemic Upper Limb with Complete Radial and Ulnar Artery Transection at a Peripheral Medical Setup: Case Report

“…4 Prichayudh also reported the use of MESS in 19 patients with scores >7, of which 12 limbs were successfully salvaged. 5 In our patient the MESS score was 8, as evaluated by his age, transient hypotension, and pulseless extremity with poor capillary refill and very high energy trauma with contaminated soft tissue. Since this patient was full stomach and also under the influence of alcohol, regional anaesthesia was considered, keeping in view the superior quality analgesia, decreases the opioid usage, and also shorter time to regain ambulation post procedure, brachial plexus block was preffered.…”

Histopathological evaluation of the arterial wall damage in upper limb injuries

“…[6,8,[15][16][17][18] This is probably the result of several contributing factors. [8,[18][19][20] Due to the complexity of the artery injury and the limitations of the imaging studies, it is still difficult to reveal all lesions of the interested arteries in certain cases. All these factors contribute to the difficulty in determining the arterial damage and injury severity in the upper extremity crush injuries.…”

“…[21][22][23][24] The severity of the arterial injury can be assessed more accurately with the combination of imaging data, histopathological assessment, and the direct intraoperative visualization. [19,20] Optimal treatment can be also suggested accordingly, which should be the priority of the developing treatment guidelines for the artery injuries.…”

Operative exposure and management of axillary vessel injuries

“…1, 2, 3) [11,19]. Patients with a proximity injury to the axillary artery without completely defined indications for operative exploration should also undergo angiography, since significant injuries could be present and can thus be identified in asymptomatic patients [1,19].…”