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Mangled extremity: to salvage or not to salvage?
  1. Kevin Bain,
  2. David Parizh,
  3. Anthony Kopatsis,
  4. Ramamohan Kilaru
  1. Department of General Surgery, NYU Lutheran, Brooklyn, New York, USA
  1. Correspondence to Dr David Parizh, david.parizh{at}

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A man aged 34 years post jump from the platform onto an incoming train presented as a level I trauma notification with bilateral mangled lower extremities and tourniquets in place (figure 1). Our patient was evaluated in a multidisciplinary fashion, making sure to follow proper ATLS guidelines. On presentation, he was hypotensive, but responded to crystalloid and blood products. Secondary survey revealed pulseless, paralysed extremities that lacked sensation and were grossly contaminated. The Mangled Extremity Severity Score (MESS) calculated as 9.1 With …

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