Journal Title: تابستان 86
Article title: Treatment Results of Vascular Repair Surgery Regarding to MESS Preoperatively in Al-Zahra Hospital in 1995 till 2005

Article PDF File:
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Article abstract:
Introduction & Objective: Appropriate management of extremity injuries results in limb salvage but such attempts in severe injuries may cause several complications. These complications are due to restoration of perfusion to ischemic tissues and include: respiratory failure, renal failure, decreased level of consciousness and decreased cardiac output. These can disturb managing patient, both intraoperatively and postoperatively. Thus predicting such events preoperatively, can help in better management . We are aiming at assessing outcome and complications of limb vascular repair operations, regarding MESS preoperatively. Materials & Methods: As a descriptive - analytic study, we evaluated all patients operated due to extremity vascular injuries during years 1995-2005. An score named Mangled Extremity Severity Score (MESS) was calculated for each patient, using certain clinical criteria including: skeletal/soft tissue injuries, limb ischemia, shock and age. Then patients divided into two groups: one with scores less than 7 and the other with scores 7. Relative frequency was calculted for certain complications in each group and then the results were compared and analyzed statistically by Fisher's Exact Test. Results: Of 68 patients, 54 had MESS<7 and 14 had MESS 7. Relative frequency of intraoperative complications, including hypotension, need to vasopressors, and acid - base disturbance were 50%, 14.3% and 92.9% in group with MESS 7 and 13%, zero and 29.6% in group with MESS<7, respectively. Relative frequency of postoperative complications, including mechanical ventilation, delay in extubation, limb reoperation, limb amputation, mortality and cardiac arrest were 25%, 35.7%, 72.7%, 72.7%, 28.6% and 28.6% in group with MESS 7 and 2%, 1.9%, 13.2%, 7.5%, 1.9% and 3.8% in group with MESS<7, respectively. Mean of bicarbonate and blood infused intraoperatively were 0.4 0.9 vial and 3.3 2.7 unit in group with MESS<7 and 2.4 3.3 vial and 7.3 5.4 unit in group with MESS 7, respectively. Mean of BUN and creatinine 24 hour after operation and duration of hospitalization were 18 6mg/dl, 0.9 0.3mg/dl and 8.8 8.2 days in group with MESS<7 and 31 14mg/dl, 1.6 1.2mg/dl and 17.7+11 days in group with MESS 7, respectively. There were no statistically significant difference in mean of fluids infused intraoperatively, relative frequency of acid - base disturbance and mean of GCS, both 24 hours after operation, comparing two groups. Conclusions: Relative frequency of complications in patients with MESS 7 was significantly more than those with MESS<7 and limb salvage efforts, when not indicated, caused more severe complications and poorer prognosis.
Article KeyWords:
Trauma, Vascular Repair Surgery, Amputation, MESS
Article Authors:

	دكتـر علي‌اكبـر بيگي	First Author
	دكتر مهـرداد قريشي	Other Author
	دكتر محمد گلپـرور	Other Author
	دكتر محسن محمـوديه	Other Author
	دكتر مـروا طهماسبي‌راد	Other Author
	دكتـر سياوش صحت	Other Author