Mangled extremity: to salvage or not to salvage?

Description

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 all factors considered, the patient was emergently taken to the operating theatre for left above knee and right below knee amputations.

Figure 1

Bilateral mangled lower extremities with a calculated Mangled Extremity Severity Score of 9 in a man aged 34 years who attempted suicide by jumping from a train platform.

The mangled extremity represents complex...

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