When responding to extreme trauma that involves severed or detached limbs, physicians and surgeons must take a number of factors into consideration. Often replantation—reattachment of the limb—is a possibility. To assess a particular case, doctors use a diagnostic tool called the M.E.S.S. test. M.E.S.S. stands for the Mangled Extremity Severity Score; the system allows doctors to evaluate factors relevant to limb replantation by assigning points to each, adding them up, and ending with a final figure. The lower the number, the more likely replantation will be successful.
The factors measured in the M.E.S.S. include the following:
- Body temperature
- Circulation
- Numbness
- Paralysis
- Tissue health
- Age and general wellness of the patient
- Length of time the limb has been without blood flow (if applicable)
Physicians and surgeons also take into account additional considerations (although they do not contribute to the M.E.S.S.) when amputation is an option. For example, the wishes and lifestyle of the patient are very influential. If the patient is used to being very active and will clearly suffer a deeply diminished quality of life if his or her leg is amputated, the surgeon may go to greater lengths or take greater risks in an attempt to save the leg. Conversely, if the patient is non-ambulatory to begin with and has a bacterial infection in his or her leg, amputation might make more sense even though the M.E.S.S. is low.
Amputation is a difficult decision for doctors to make. If a doctor fails to take into account the proper factors, he or she could end up making an irreversible decision that causes the patient severe pain and suffering. In a court case, it could even be viewed as medical malpractice.
Dr. Michael M. Wilson is an attorney and a physician who earned his undergraduate degree from the Massachusetts Institute of Technology and his legal and medical degrees from Georgetown University. He has focused in the area of medical malpractice for more than three decades and secured more than $100 million in settlements and verdicts on behalf of clients throughout the country. He is admitted to practice in the District of Columbia and New York as well as the U.S. Court of Appeals for the District of Columbia and the U.S. Supreme Court. He is listed in America’s Top 100 High Stakes Litigators.
