Abdulmalik Adel, Salem Elmabsout and Randa Aldaghili
Landmine Injury to the foot and ankle as high-force energy can be devastating to a different structure including bone, muscles, vessels, and nerves. The degree of tissue destruction and often other surgical evaluation most likely to affects the decision of whether to amputate or attempt a reconstruction. In Literature, previous studies show that immediate amputation in patients with high Mangled Extremity Severity Score (MESS) had a very good prognosis compared with reconstruction. In this paper, we report a case of a 28-male presented to the Emergency Department at ALJALA hospital after 30 minutes of crushing his right foot by direct contact with a landmine. Assessment of the patient revealed poor general state and the foot was severely mangled despite >7 on Mangled Extremity Severity Score (MESS). Limb salvage was used with Aggressive debridement, reduction with external fixation, skin graft with big toe amputation and later replace of skin graft with sural flap. After one year of treatment, all wounds healed completely with little pain, satisfactory motor and sensory functions were achieved and the patient returns to his previous job as vehicle driver. In conclusion, the treatment of mangled extremity should be based on clinical evaluation of every patient. Guidelines and scores are helpful, but should not be considered as fundamental criteria in clinical decisions.
