Recent advances in trauma management, vascular
reconstruction, nerve grafting and vascular tissue transfer have
dramatically extended the posibility to preserve a mangled limb,
however, this approach frequently originates increased morbidity.
In addition, early amputation could have legal implications
to take in account. Although most easily identified, skeletal
injury is not the primary factor determining viability and functional
potential; vascular, neurologic and, especially, soft-tissue
injuries play a much important role in predicting the survival and
ultimate function of a mangled extremity. We report 4 cases
treated in our Hospital. We retrospectively calculated the
Mangled Extremity Severity Score (MESS) punctuation, which
is based on four clinical criteria. Efforts should be directed at
establishing objective clinical guidelines to improve surgeon's
experience when facing the difficult decision of amputation or
salvage.

Recent advances in trauma management, vascular
reconstruction, nerve grafting and vascular tissue transfer have
dramatically extended the posibility to preserve a mangled limb,
however, this approach frequently originates increased morbidity.
In addition, early amputation could have legal implications
to take in account. Although most easily identified, skeletal
injury is not the primary factor determining viability and functional
potential; vascular, neurologic and, especially, soft-tissue
injuries play a much important role in predicting the survival and
ultimate function of a mangled extremity. We report 4 cases
treated in our Hospital. We retrospectively calculated the
Mangled Extremity Severity Score (MESS) punctuation, which
is based on four clinical criteria. Efforts should be directed at
establishing objective clinical guidelines to improve surgeon's
experience when facing the difficult decision of amputation or
salvage.