Application of the mangled extremity severity score in a combat setting

Objective: The aim of this study was to examine the Mangled Extremity Severity Score (MESS) in a combat setting. Methods: Data on extremity injuries were collected from a forward surgical team. MESS and Revised Trauma Score values were retrospectively calculated for each patient. Student's t test was used to compare amputated and salvaged limbs. Results: A total of 60 extremities was identified in 49 patients. There were 10 major vascular repairs (20%). MESS values differed significantly for the eight amputations performed (mean MESS, 7.87 ± 1.91) and 50 salvaged extremities (mean MESS, 2.44 ± 0.438; p = 0.001). Conclusions: A MESS of >7 correlated with amputation, thus validating the MESS in a combat setting. A young average patient age and high-energy injury mechanism on the battlefield leave ischemic time and shock as the most important factors in dictating whether a MESS is >7 or <7.