aka MESS
Johansen et al 1990
No score is an absolute predictor of need for amputation, but only acts as a guide
Better to use in conjunction with sensibility of plantar foot & reconstruction needed
Memory Aid
- “VISA gives you double frequent flyer points after 6 hours”
- Vascularity
- Injury
- Shock
- Age
Vascularity/ Limb Ischaemia*
- Poor pulse 1
- Pulseless & poor CR 2
- Totally avascular 3
*Score doubled for ischaemia > 6/24
Injury Skeletal/ Soft-tissue
- Low Energy 1
- Medium Energy 2
- High Energy 3
- Very High Energy 4
Shock
- Systolic BP > 90mmHg 0
- Hypotensive transiently 1
- Persistent hypotension 2
Age (Years)
- < 30 0
- 30-50 1
- > 50 2
Helfet Clin Orthop 1990:
- Objective criteria can predict amputation after lower-extremity trauma
- MESS was prospectively evaluated
- In 26 lower-extremity open fractures with vascular injury
- 4.00 for the 14 salvaged limbs
- 8.83 for the 12 amputated limbs
- In 26 lower-extremity open fractures with vascular injury