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Modifying factors Loss of posterior tibial nerve causes trophic ulceration; ischemia > 6 hours doubles the MESS
MESSMangled Extremity Severity Score Traumatology A scoring system used to evaluate the need for amputation in an extremity; a MESS of ≥ 7 indicates a need to amputate Altering factors Loss of posterior tibial nerve causes trophic ulceration, ischemia > 6 hrs doubles score. See Amputation.
MESS scoring points
Skeletal & soft tissue injury
• Low energy–stabs, simple Fx, civilian gun shot wounds
• Medium energy–open or multiple Fx, dislocation
• High-energy–close range shotgun, military gunshot wounds, crush injury
• Very high energy–as in line just above, with gross contamination or tissue avulsion
• Pulse reduced, normal perfusion
• Pulseless, paresthesia, ↓ capillary filling
• Cool, paralyzed, numb
• Systolic BP ≥ 90 mm Hg
• Transient hypotension
• Permanent hypotension
• < Age 30
• Age 30–50
• > Age 50
Mangled Extremity Severity Score,
An assessment tool used in trauma patients to predict the likelihood that an injured arm or leg will require amputation. MESS takes into account the age and blood pressure of the patient, the type of injury, and the perfusion of the injured limb.