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