{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T07:56:36Z","timestamp":1758873396621,"version":"3.44.0"},"reference-count":10,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,5,20]]},"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:p>Management of a severely damaged extremity poses a dilemma\u2014whether to perform a primary amputation or attempt limb salvage. A multitude of factors\u2014such 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\u2014influence 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.<\/jats:p>","DOI":"10.1136\/bcr-2023-254629","type":"journal-article","created":{"date-parts":[[2023,6,15]],"date-time":"2023-06-15T12:35:14Z","timestamp":1686832514000},"page":"e254629","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Salvage of a severely mangled limb following traumatic injury"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6111-4237","authenticated-orcid":false,"given":"Rakesh Kumar","family":"Jha","sequence":"first","affiliation":[{"name":"Department of Surgery, Indian Naval Hospital Ship Asvini, Mumbai, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prasad Vijay","family":"Jayaram","sequence":"additional","affiliation":[{"name":"Department of Surgery, Indian Naval Hospital Ship Asvini, Mumbai, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramakrishnan","family":"Shankaran","sequence":"additional","affiliation":[{"name":"Department of Surgery, Indian Naval Hospital Ship Asvini, Mumbai, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7868-9248","authenticated-orcid":false,"given":"Hari Janardhan","family":"Pillai","sequence":"additional","affiliation":[{"name":"Department of Surgery, INHS Jeevanti, Vasco-de-Gama, Goa, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,6,15]]},"reference":[{"key":"2025082710353605000_16.6.e254629.1","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.jamcollsurg.2021.04.012","article-title":"A leg to stand on: trauma center designation and association with rate of limb salvage in patients suffering severe lower extremity injury","volume":"233","author":"Bunn","year":"2021","journal-title":"J Am Coll Surg"},{"key":"2025082710353605000_16.6.e254629.2","article-title":"Limb salvage versus amputation for the mangled extremity: factors affecting decision-making and outcomes","volume":"14","author":"Okereke","year":"2022","journal-title":"Cureus"},{"key":"2025082710353605000_16.6.e254629.3","doi-asserted-by":"crossref","unstructured":"Bhanu TK . Mangled extremity severity score - is it really useful in assessing limb salvage following open and crush injuries in the lower extremity. Int J Emerg Med 2014;7. doi:10.1186\/1865-1380-7-S1-P6","DOI":"10.1186\/1865-1380-7-S1-P6"},{"key":"2025082710353605000_16.6.e254629.4","doi-asserted-by":"crossref","unstructured":"Qureshi MK , Ghaffar A , Tak S , et al . Limb salvage versus amputation: a review of the current evidence. Cureus 2020;12. doi:10.7759\/cureus.c38","DOI":"10.7759\/cureus.10092"},{"key":"2025082710353605000_16.6.e254629.5","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1002\/bjs.9689","article-title":"Meta-analysis of Prognostic factors for amputation following surgical repair of lower extremity vascular trauma","volume":"102","author":"Perkins","year":"2015","journal-title":"Br J Surg"},{"key":"2025082710353605000_16.6.e254629.6","doi-asserted-by":"crossref","DOI":"10.1136\/tsaco-2020-000616","article-title":"Patency of arterial repairs from wartime extremity vascular injuries","volume":"5","author":"Haney","year":"2020","journal-title":"Trauma Surg Acute Care Open"},{"key":"2025082710353605000_16.6.e254629.7","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1016\/j.jvs.2018.07.075","article-title":"Impact of time to repair on outcomes in patients with lower extremity arterial injuries","volume":"69","author":"Alarhayem","year":"2019","journal-title":"J Vasc Surg"},{"key":"2025082710353605000_16.6.e254629.8","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1016\/j.injury.2010.05.003","article-title":"A meta-analysis of amputation versus limb salvage in mangled lower limb injuries--the patient perspective","volume":"42","author":"Akula","year":"2011","journal-title":"Injury"},{"key":"2025082710353605000_16.6.e254629.9","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.15.01210"},{"key":"2025082710353605000_16.6.e254629.10","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1186\/s12891-015-0832-7","article-title":"Primary amputation vs limb salvage in mangled extremity: a systematic review of the current scoring system","volume":"16","author":"Schir\u00f2","year":"2015","journal-title":"BMC Musculoskelet Disord"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-254629","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:35:42Z","timestamp":1756316142000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-254629"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6]]},"references-count":10,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6,15]]},"published-print":{"date-parts":[[2023,6]]}},"alternative-id":["10.1136\/bcr-2023-254629"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-254629","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2023,6]]}}}