Gustilo IIIC injury of the thigh, MESS score 11, slow oozing of blood on needling the end of the toe, limb preservation successful: A case report.

RATIONALE

For limb Gustilo type IIIC injuries with a Mangled Extremity Severity Score (MESS) ≥7, amputation is often necessary. However, due to advancements in surgical techniques, limb preservation is also feasible for some of these patients. There is still no consensus on the reliability of existing scoring systems for determining amputation or limb preservation.

PATIENT CONCERNS

A patient presented with a Gustilo type IIIC injury of the thigh, absolute indications for amputation (thermal ischemia duration nearly 19 hours, MESS score of 11), but had slow oozing of blood on needling the end of the toe.

DIAGNOSES

Gustilo type IIIC injury of the thigh with prolonged ischemia and high MESS score.

INTERVENTIONS

The treatment plan was immediately changed from amputation to limb preservation. The femur was overlapped, the limb was shortened by 5 cm in one stage and fixed with an external frame. The femoral artery defect (up to 6 cm) was managed with direct end-to-end anastomosis after freeing. After viability was confirmed, a second stage lengthened the limb to normal length and internal fixation was performed for the femoral stem fracture.

OUTCOMES

The limb was successfully preserved, and good lower limb function was achieved.

LESSONS

Even for Gustilo type IIIC injuries with a MESS score ≥7, if slow oozing of blood is observed at the end of the needled limb, active limb preservation should be considered. One-stage limb shortening to rapidly restore blood flow and 2-stage lengthening to recover limb length are practical techniques conducive to successful limb preservation.