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Case Reports: Learning from unexpected outcome (positive or negative)
Salvage of a severely mangled limb following traumatic injury
  1. Rakesh Kumar Jha1,
  2. Prasad Vijay Jayaram1,
  3. Ramakrishnan Shankaran1 and
  4. Hari Janardhan Pillai2
  1. 1Department of Surgery, Indian Naval Hospital Ship Asvini, Mumbai, Maharashtra, India
  2. 2Department of Surgery, INHS Jeevanti, Vasco-de-Gama, Goa, India
  1. Correspondence to Dr Prasad Vijay Jayaram; prasad59{at}gmail.com

Abstract

Management of a severely damaged extremity poses a dilemma—whether to perform a primary amputation or attempt limb salvage. A multitude of factors—such as the extent of neurovascular injury, limb ischaemia time, severity of bone and soft tissue loss, physiological reserve of the patient and availability of surgical expertise and resources—influence this decision. The Mangled Extremity Severity Score (MESS) was developed as a predictor of the need for limb amputation, and a MESS of 7 or more is considered a predictor of primary amputation. Here we describe a case where a man in his 20s sustained traumatic avulsion of his right ankle with severe neurovascular damage and multiple tendon injuries onboard a ship at high sea. Despite a MESS of 10, limb ischaemia time of more than 10 hours and injuries to all three extremity vessels (anterior tibial, posterior tibial and peroneal arteries), limb salvage was successfully carried out at a level-II trauma centre.

  • Orthopaedic and trauma surgery
  • Vascular surgery
  • Plastic and reconstructive surgery

https://doi.org/10.1136/bcr-2023-254629

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    Footnotes

    • Contributors RKJ, RS, PVJ and HJP were the primary treating surgeons of the patient and were involved closely in his follow-up. The case report was drafted by PVJ under the guidance of RJ.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.