Formulation of a Vascular Trauma Scoring System to predict extremity salvage and A Clinical Comparision study with Mangled Extremity Severity Scoring(MESS).

Anand, V (2007) Formulation of a Vascular Trauma Scoring System to predict extremity salvage and A Clinical Comparision study with Mangled Extremity Severity Scoring(MESS). Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Vascular trauma is a common component of polytrauma and requires prompt recognition, urgent resuscitation, early evacuation to a vascular centre for life and limb salvage. Longer the duration of ischemia, greater is the threat to the limb, increased infection rates and consequently poor outcome of revascularization attempts. This study concentrates on certain limb injuries, which present with crush injury and extensive soft tissue damage, concomitant vascular and/or nerve injury and major bony disruption. During the past few decades, better understanding of the injury itself and technical advances in surgery (allowing revascularization of the extremity, stabilization of the complex fracture, and reconstruction of the soft tissues) and rehabilitation have led to an increased frequency of attempts at limb salvage. In some of these patients, however, limb salvage may have subsequent deleterious results, which is associated with a high morbidity and poor prognosis and often requires late amputation (27 – 70%) despite initial success. In these cases, early or primary amputation might even be beneficial. Attempts to qualify the severity of the trauma and to establish numerical guidelines on whether to amputate or salvage the limb have been proposed by several authors. Published scoring systems of lower extremity injury include the Mangled Extremity Severity Score (MESS), Predictive Salvage Index (PSI), Nerve injury, Ischemia, Soft tissue injury, Skeletal injury, Shock, Age of patient (NISSSA) and Mangled Extremity Syndrome Index (MESI). The developers of these scoring systems attempted to validate them by demonstrating high rates of specificity and sensitivity in predicting limb salvage. However, independent testing of some of these scoring systems has not duplicated the success reported by the developers. It is pertinent to note that although a vascular surgeon is one of the prime determiners of decision taken for limb salvage, there is no vascular scoring system to predict limb salvage. AIM : The aim of this dissertation is to formulate and assess a Vascular Trauma Score, compare the score with Mangled Extremity Severity Score (MESS) and evaluate both to predict limb salvage in patients with vascular injuries. CONCLUSION : Extremity trauma continues to challenge vascular surgeons in aspects of deciding as to when amputation or attempt at revascularization is appropriate. MESS in our clinical setup was found to be inadequate in this crucial decision and thus MMC score was evolved. This score has a high sensitivity and specificity in predicting upper and lower limb amputation as compared to MESS and can be applied to prevent futile and unnecessary attempts at salvage. MMC score has a high sensitivity and specificity for both upper and lower limbs. However lower limb sensitivity is higher than for upper limb, implying that predicting amputation in lower limb is more accurate with this score. The score is simple and can be easily applied in the emergency room with a hand held Doppler instrument. MESS has been found to be ineffective in many studies and predicting amputation only on MESS would be inadvisable. Further validation from other centers is required for uniform adaptation of the MMC score. With increasing involvement of vascular surgeons in limb salvage or for decision making for primary amputation, a vascular trauma score would help in arriving at a consensus for individual surgeons to achieve a common goal.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Vascular Trauma Scoring System ; salvage ; Mangled Extremity Severity Scoring ; Clinical Comparision study.
Subjects: MEDICAL > Vascular Surgery
Depositing User: Kambaraman B
Date Deposited: 24 Jul 2017 02:04
Last Modified: 24 Jul 2017 02:04

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