Revalidation of mangled extremity severity score system to predict limb salvage in lower limb traumatic injury

Background: High-energy lower extremity trauma is a major challenge. Many affected patients are young, and advances in reconstructive surgery now allow limb salvage in injuries once managed by amputation.Objective: To revalidate the Mangled Extremity Severity Score (MESS) for lower limb trauma by following patients with scores of 6, 7, or 8 who underwent limb salvage.Methods: Forty-five patients with severe lower limb injuries and MESS scores of 6, 7, or 8 at Ain Shams University Hospitals were prospectively followed after attempts at limb salvage.Results: New techniques and multidisciplinary cooperation have improved limb salvage rates, though risks of morbidity, longer hospitalization, and costs remain. Severity grading like MESS helps guide amputation decisions but does not predict functional recovery.Conclusion: MESS is a simple and practical tool for guiding management in severe lower limb trauma. Patients with MESS scores of 7 or 8 may benefit from reconstruction attempts before considering primary amputation.