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Int J Angiol 2021; 30(02): 098-106
DOI: 10.1055/s-0040-1720970
Original Article

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

Ahmed Mousa 
1   Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
2   Division of Vascular Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
,
Ossama M. Zakaria
3   Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
4   Division of Pediatric Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
,
Mai A. Elkalla
5   Faculty of Medicine, Helwan University, Cairo, Egypt
,
Lotfy A. Abdelsattar
6   Department of General Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
,
Hamad Al-Game'a
7   College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
› Author Affiliations Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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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

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

Note

The study was approved by the research board ethical committee of the Department of Vascular Surgery of the University Hospitals, Al-Azhar Faculty of Medicine for Males, and recorded under registration number: (25/08–01/2019).


All procedures performed in study involving human participants were in accordance with the ethical standards of the institutional/national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


Authors' Contributions

A.M., O.M.Z., and L.A.A. made a substantial contribution to the concept or design of the work or acquisition, analysis, or interpretation of data.


A.M., O.M.Z., M.A.E., L.A.A., and H.A. drafted the article or revised it critically for important intellectual content.


A.M., O.M.Z., M.A.E., L.A.A., and H.A. approved the version to be published.


A.M. O.M.Z., M.A.E., L.A.A., and H.A. each author have participated sufficiently in the work to take public responsibility for appropriate portions of the content.


All authors read, revised, and approved the manuscript carefully for final publication.




Publication History

Article published online:
26 November 2020

© 2020. International College of Angiology. This article is published by Thieme.

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