Re: Outcome after revascularisation of marginally viable limbs and dead limbs following lower limb arterial injuries Ceylon Medical Journal 2017; 62: 203-204

In order to allow scientific comparison and scrutiny, an acutely ischemic limb must be defined and classified according to established clinical criteria using Rutherford classification (class I, II and III) The Mangled Extremity Severity Score (MESS) should be included to define the extent of soft tissue (skin, muscle and nerve) and bone injuries in the setting of arterial ischemia due to highvelocity injury or severe blunt trauma. A patient with Rutherford class III ischemia will be at prohibitively high risk of reperfusion injury following revascularization. Therefore, primary amputation is considered a safer alternative for these patients. However, for a patient with Rutherford class IIB ischemia, an immediate revascularization procedure is required. Limb salvage is often futile in patients with a mangled extremity (MESS score <7).