Evaluation of mangled extremity severity score (MESS) as a predictor of lower limb amputation in children with trauma

摘要

It was with great interest that we read the article by Behdad et al on the use of the mangled extremity severity score (MESS) in children. We take issue with the recommendations of that article and wish to highlight them here. The authors describe their experience with 200 Grade 3B and 3C fractures over the course of 1 year. All primary amputations were excluded from analysis-meaning that all the amputations they present represented failures of attempted reconstruction. At a rate of 7.5% for amputations over 1 year, the level of reconstructive failure is extraordinarily high. It also precludes any examination of the utility of the MESS score in predicting the need for primary amputation when those children undergoing this procedure are not evaluated. No comment is made as to the use or efficacy of microvascular free tissue transfer in their institution.