Mangled Extremity Severity Score

>Trauma Surgery >Mangled Extremity Severity ScoreAuthor: J. Sprakel, MD - Latest update: 01-02-2015

Mangled Extremity Severity Score

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Mangled Extremity Severity Score (MESS)

Type Characteristics Injuries Points
Skeletal / soft-tissue group
1 Low-energy - Stab wounds, simple closed fractures, small-caliber gunshot wounds 1
2 Medium-energy - Open or multiple level fractures, dislocations, moderate crush injuries 2
3 High-energy - Shotgun blast (close range) high-velocity gunshot wounds, crush injury 3
4 Very high-energy - Above + gross contamination, soft tissue avulsion 4
Shock group
1 Normotensive hemodynamics - BP stable in field an in operation theatre 0
2 Transiently hypotensive - BP stable unstable in field but responsive to intravenous fluids 1
3 Prolonged hypotension - Systolic BP less than 90mmHg in field and responsive to intraveneous fluids only in operation theatre 2
Ischemia group
1 None - A pulsatile limb without signs of ischemia 0 *
2 Mild - Pulse reduced or absent but perfusion normal 1 *
3 Moderate - Pulseless, parasthesia, dimished capillary refill 2 *
4 Advanced - Pulseless, cool, paralyzed and numb without capillary refill 3 *
Age group
1 < 30 year 0
2 >30 - <50 year 1
3 > 50 year 2
* Points x 2 if ischemia time exceeds six hours, BP = blood pressure


MESS score of 6 or lower: consistent with limb salvage
MESS score of 7 or higher: usually amputation