Initial stabilization and resuscitation (i.e., ABC's) of the patient with traumatic amputated parts take precedence to all other procedures and evaluation. Mechanism of injury, general health status, the warm ischemia time passed, associated life- and limb-threatening injuries, comorbid illnesses, the energy level applied to the extremity, extent of soft-tissue injury should be sought and documented. Although replantation is in general, technically possible for complete and subtotal extremity amputations, the decision process is not so easy provided with the limited functional outcome. Nonetheless, cleanly separated amputations in young victims who possess no significant risk factors should be considered candidates for replantation.

In the context of the 'mangled' extremity, MESS proves to be a useful tool to evaluate and discriminate those injuries to undergo primary or 'early' amputation from those to be salvaged. A total MESS score of 7 or more indicates the need for primary amputation. A complete evaluation and management of these injuries mandates an organized team approach and timely sequence of interventions.

Keywords: amputation, mangled extremity, avulsed parts, emergency medicine, replantation