الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 173 |  |  |
| | | from | 173 | | |
Abstract
Abstract
Abstract.
Objectives: Severe limb trauma with vascular injury presents challenges with regard to reconstruction and rehabilitation. Extremity injury-severity scoring systems were developed to assist the surgical team with the initial decision to amputate or salvage a limb. The objective of the present study was to evaluate prospectively the clinical effectiveness of the mangled extremity scoring system (MESS) and the limb salvage index (LSI) to assist the surgeons in decision making to do extensive reconstruction or primary amputation. In addition to predict variable associated with failure of limb salvage.
Patient and method: This is a cohort prospective comparative study including 50 consecutive patients with severely injured limbs obtained from Beni Suef University Hospital from September 2015 to April 2017. Patients were divided into two groups according to outcome that are functional limb group and non-functional limb group. Data were analyzed using the software, Statistical Package for Social Science, (SPSS) version 20, then processed and tabulated. Chi-square, t-test, correlations were done whenever needed. P values of less than 0.05 were considered significant. Results were represented in tables using Microsoft Excel 2013.
Results: 50 patients were included: with 84%males; mean age 23.26 years; and (80%) victims of traffic accidents. Right lower limbs fractures were significantly more prevalent (44%). Six patients were subjected to unfavorable outcome. Factors that are significantly associated with unfavorable outcome are prolonged hypotension, prolonged ischemia time, compartmental syndrome, muscle laceration or crushed muscle, large skin avulsion and complete transection of popliteal or superficial femoral arteries. The MESS sensitivity was 83.3%, specificity was 97.7% and LSI sensitivity was 100%, specificity was 95.5%. The LSI was larger than 6 in 100% of non-functional limb group and less than 6 in 95.5% in functional limb group.
Conclusion: Currently available injury severity scores are not predictive of the functional recovery of patients who undergo successful limb reconstruction. Predictors of unfavorable outcome according to our study are high MESS and LSI scores, prolonged hypotension, prolonged ischemia time, compartmental syndrome, muscle laceration or crushed muscle, large skin avulsion and complete transection of popliteal or superficial femoral arteries. This study gives us a clue that we can suggest the outcome depending on MESS and LSI scores about limb salvage or not of severely injured limbs but it cannot be used in decision making for such hazardous decision.