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

Vascular ◽  
2012 ◽  
Vol 20 (6) ◽  
pp. 321-324 ◽  
Author(s):  
Mohamed A Elsharawy ◽  
Karay Maher ◽  
Aymen S Elsaid
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Clinical Picture ◽  
Scoring Systems ◽  
Severely Injured ◽  
Ischemic Limb ◽  
Mangled Extremity ◽  
Severity Scores

Most surgeons make their decision to amputate or perform limb salvage of a mangled extremity based on scoring systems and grading of acute ischemic limb. We report on a child in whom limb salvage was achieved in spite of a clinical picture of irreversible ischemia with high mangled severity scores. Attempts to revascularize the mangled extremity of children are recommended, regardless of their severity scores and condition of the foot.

scholarly journals Utility of mangled extremity severity score in severely injured lower limbs

2017 ◽  
Vol 18 (1) ◽  
pp. 23-25
Author(s):  
Toya Raj Bhatta ◽  
B Gyawali ◽  
R Tamrakar ◽  
BK Acharya ◽  
SK Shrestha ◽  
...  
Keyword(s):  
Decision Making ◽  
Lower Extremity ◽  
Severity Score ◽  
Treatment Protocol ◽  
Lower Limbs ◽  
Common Mechanism ◽  
Severely Injured ◽  
Injured Limb ◽  
Mangled Extremity ◽  
Significant Difference

Introduction: Massive lower extremity trauma,in particular open tibial fractures with associated vascular injuries, present an immediate and complex decision-making challenge between a limb salvage attempt and primary amputation. Medical and surgical advances of the past two decades have improved the ability to reconstruct severely injured limb. Limbs that once would have been amputated are now routinely managed with complex reconstruction protocol. Mangled extremity severity score is one of the scoring systems to predict the fate of limbs after severe limb injuries.Methods: Patients fulfilling the inclusion criteria were evaluated with MESS, at the same time treatment protocol for management of injuries of lower limb were followed independently by attending orthopedic surgeon. Mean MESS for salvaged and amputated limbs were calculated and its reliability for prediction of fate of injured limb was assessed using software SPSS v16.Result: The age of patient ranges from 10 to 65 yrs with mean age 35.83. The most common mechanism of injury was Road Traffic Accident followed by fall from height. The mean MESS score for salvaged limbs was 4.18 and for amputated limbs was 8.12 suggesting significant difference in mean scores. The sensitivity (the probability that limbs requiring amputation will have MESS at or above 7) was found to be 75%. The specificity of MESS (the probability that salvage limbs will have MESS < 7) was 95.45%.Conclusion: MESS is a reliable indicator in decision making process whether a limb can be salvaged or needs amputation. The mangled lower extremity with the score of less than 7 may be salvaged and 7 or more may need amputation.JSSN 2015; 18 (1), Page: 23-25

Treatment of Arterial Ulcers

2018 ◽  
Author(s):  
Vahram Ornekian ◽  
David E Janhofer ◽  
Cameron Akbari ◽  
Karen K Evans
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Systematic Approach ◽  
Diagnostic Testing ◽  
Treatment Strategies ◽  
Arterial Disease ◽  
Management Guidelines ◽  
Ischemic Limb ◽  
Life Threatening ◽  
Peripheral Arterial

Ischemic ulceration of the lower extremity is a challenging problem that requires a careful, systematic approach to achieve healing and favourable outcomes. Ulceration may become limb and life threatening, and limb salvage requires a concerted, multispecialty approach that includes vascular surgeons, plastic surgeons, and podiatrists among others. In this chapter, we propose an algorithm for the evaluation and treatment of ischemic ulceration of the lower extremity. We provide a review of management guidelines, including a discussion of important considerations for appropriate history taking, physical examination evaluation, diagnostic testing modalities, and medical and surgical treatment strategies, taking into account patient functional and ambulatory goals of care. This review contains 8 figures, 4 tables and 73 references Key Words: amputation, diabetes, ischemic, limb salvage, lower extremity, peripheral arterial disease, reconstruction, revascularization, ulcer, wound

scholarly journals Initial Limb Salvage Intervention for a Mangled Lower Extremity in a Four-Year-Old Male: A Case Report of the Alternatives in Low-resource Settings

2021 ◽  
Vol 25 (3) ◽  
Author(s):  
Kofi Tawiah Mensah
Keyword(s):  
Case Report ◽  
Limb Salvage ◽  
Low Resource Settings ◽  
Low Resource ◽  
The Road ◽  
Mangled Extremity ◽  
Successful Case ◽  
Severity Scores ◽  
Emergency Units ◽  
Extremity Injuries

Introduction: Mangled extremity injuries in civilian settings are challenging conditions for the accident and emergency units of low-resource settings where salvage therapies may not be feasible or affordable for the patients. Case Report: We have described a successful case of initial conservative limb salvage management for a mangled distal left lower limb in a four-year-old male who sustained the injury when a vehicle ran over his extremity as he played by the road. The treatment approach was in contrast to the radical completion of amputation with its attendant revisions, which are associated with similar injuries with the mangled extremity severity scores of ≥ 7. Conclusions: The benefits and challenges of the limb salvage intervention were discussed based on the literature in this regard, and a recommendation was proposed while considering an initial conservative limb salvage approach in well-resuscitated children presenting early with a mangled extremity injury.

scholarly journals Ability of Lower-Extremity Injury Severity Scores to Predict Functional Outcome After Limb Salvage

2008 ◽  
Vol 90 (8) ◽  
pp. 1738-1743 ◽  
Author(s):  
Thuan V Ly ◽  
Thomas G Travison ◽  
Renan C Castillo ◽  
Michael J Bosse ◽  
Ellen J MacKenzie
Keyword(s):  
Lower Extremity ◽  
Functional Outcome ◽  
Limb Salvage ◽  
Injury Severity ◽  
Lower Extremity Injury ◽  
Extremity Injury ◽  
Severity Scores

scholarly journals Primary amputation versus limb salvage in upper limb major trauma: a systematic review

2021 ◽  
Author(s):  
Sandeep Krishan Nayar ◽  
Harry M. F. Alcock ◽  
Dafydd S. Edwards
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Limb Salvage ◽  
Upper Limb ◽  
Major Trauma ◽  
Scoring Systems ◽  
Psychological Outcomes ◽  
Mangled Extremity ◽  
Primary Amputation ◽  
Limb Injuries

Abstract Purpose Severe upper limb injuries can result in devastating consequences to functional and psychological well-being. Primary objectives of this review were to evaluate indications for amputation versus limb salvage in upper limb major trauma and whether any existing scoring systems can aid in decision-making. Secondary objectives were to assess the functional and psychological outcomes from amputation versus limb salvage. Methods A systematic review was carried out in accordance with PRISMA guidelines. A search strategy was conducted on the MEDLINE, EMBASE, and Cochrane databases. Quality was assessed using the ROBINS-I tool. The review protocol was registered in PROSPERO. Results A total of 15 studies met inclusion criteria, encompassing 6113 patients. 141 underwent primary amputation and 5972 limb salvage. General indications for amputation included at least two of the following: uncontrollable haemodynamic instability; extensive and concurrent soft tissue, bone, vascular and/or nerve injuries; prolonged limb ischaemia; and blunt arterial trauma or crush injury. The Mangled Extremity Severity Score alone does not accurately predict need for amputation, however, the Mangled Extremity Syndrome Index may be a more precise tool. Comparable patient-reported functional and psychological outcomes are seen between the two treatment modalities. Conclusions Decision regarding amputation versus limb salvage of the upper limb is multifactorial. Current scoring systems are predominantly based on lower limb trauma, with lack of robust evidence to guide management of the upper extremity. Further high-quality studies are required to validate scoring systems which may aid in decision-making and provide further information on the outcomes from the two treatment options.

Amputation

2020 ◽  
pp. 111-124
Keyword(s):  
Scoring Systems ◽  
Prospective Analysis ◽  
Trauma Surgeon ◽  
Severely Injured ◽  
Incorrect Decision ◽  
Hard Data ◽  
Mangled Extremity ◽  
Tissue Contamination ◽  
Fracture Scale ◽  
Scoring Algorithms

The decision to amputate rather than reconstruct a severely injured limb (‘mangled extremity’) has historically been one of the most difficult choices faced by a trauma surgeon. The surgeon’s responsibility is heightened by the knowledge that delayed or incorrect decision-making may lead to worse outcomes. Unfortunately, hard data upon which to base reliable decisions remain elusive. A prospective analysis of the use of scoring systems including the Limb Salvage Index, the Predictive Salvage Index, the Hanover Fracture Scale, and the NISSSA (Nerve injury, Ischaemia, Soft-tissue contamination, Skeletal damage, Shock, Age) and MESS (Mangled Extremity Severity Score) scores did not validate the clinical utility of any of the scoring algorithms.

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