Reliability of the Mangled Extremity Severity Score in the Management of Peripheral Vascular Injuries in Children: A Retrospective Review

Abstract

This study was aimed to evaluate different management modalities for peripheral vascular trauma in children, with the aid of the Mangled Extremity Severity Score (MESS). A single-center retrospective analysis took place between 2010 and 2017 at University Hospitals, having emergencies and critical care centers. Different types of vascular repair were adopted by skillful vascular experts and highly trained pediatric surgeons. Patients were divided into three different age groups. Group I included those children between 5 and 10 years; group II involved pediatrics between 11 and 15 years; while children between 16 and 21 years participated in group III. We recruited 183 children with peripheral vascular injuries. They were 87% males and 13% females, with the mean age of 14.72 ± 04. Arteriorrhaphy was performed in 32%; end-to-end anastomosis and natural vein graft were adopted in 18% and 29% respectively. On the other hand, 20% underwent bypass surgery. The age groups I and II are highly susceptible to penetrating trauma ( p = 0.001), while patients with an extreme age (i.e., group III) are more susceptible to blunt injury ( p = 0.001). The MESS has a significant correlation to both age groups I and II ( p = 0.001). Vein patch angioplasty and end-to-end primary repair should be adopted as the main treatment options for the repair of extremity vascular injuries in children. Moreover, other treatment modalities, such as repair with autologous vein graft/bypass surgery, may be adopted whenever possible. They are cost-effective, reliable, and simple techniques with fewer postoperative complication, especially in poor/limited resources.

Keywords: above-knee amputation; bypass surgery; compartment syndrome; end-to-end vascular anastomosis; interposition reversed saphenous vein graft; pediatric extremity vascular injuries.

Fig. 1

Severely crushed lower limb undergoing primary AKA in a patient aged 21 years old. AKA, above-knee amputation.

Fig. 2

The distribution of the MESS values among injured patients. MESS, Mangled Extremity Severity Score.

Fig. 3

The Kaplan–Meier survival curves for amputation-free and vascular patency.

Fig. 4

Arterial repair using an interposition reversed saphenous vein graft.

Fig. 5

Femorodistal bypass for gunshot injury of the popliteal artery.

Fig. 6

An irreversible acute limb ischemia in a 19-year-old patient that occurs within 15 days of revision repair using an interposition reversed saphenous vein graft, because of graft infection and thrombosis. This patient underwent definitive above-knee amputation.