Mangled Extremity Severity Score

Mangled Extremity Severity Score  

 

Johansen et al 1990        

- no score is an absolute predictor of need for amputation

- only acts as a guide

- better to use in conjunction with vascular / soft tissue / bony reconstruction  required

 

"VISA gives you double frequent flyer points after 6 hours"

 

Velocity

Ischaemia

Shock

Age

 

Velocity

 

Low Energy           1

Medium Energy     2

High Energy          3

Very High Energy   4

 

Ischemia

 

Poor pulse                 1

Pulseless & poor CR   2

Totally avascular         3

 

Score doubled for ischemia > 6/24

 

Shock

 

Systolic BP > 90 mm Hg 0

Hypotensive transiently     1

Persistent hypotension      2

 

Age (Years)

 

< 30 0

30-50    1

> 50     2

 

Max = 11 or 14 if > 6hrs

 

>7 = 100% chance of amputation

 

Results

 

Helfet Clin Orthop 1990

- objective criteria can predict amputation after lower-extremity trauma

- MESS was prospectively evaluated in 26 lower-extremity open fractures with vascular injury

- 4.00 for the 14 salvaged limbs 

- 8.83 for the 12 amputated limbs p < 0.01

- MESS > 7 100% predictive value for amputation