A comprehensive scoring system to evaluate patient-centred risk factors regarding lower extremity amputation

  • M.S. Miller, E.W. Newgent, S.M. O'Connell, C. Broadus
  • Journal of Wound Care, October 2017, Mark Allen Group
  • DOI: 10.12968/jowc.2017.26.sup10.s20

A patient based scoring system to assess the appropriateness of lower extremity amputation

What is it about?

This article proposes a scale to be used when a lower extremity amputation is being considered. The decision to perform amputation is almost always based on the perception of the surgeon and others regarding their ability to heal or improve the presenting lower extremity issue that portends amputation. Unquestionably, the skills and experiences of the surgeons play a significant role in their ability to engage in limb preservation versus amputation. If they are unable, unwilling or unskilled in limb preservation, then amputation becomes their weapon of choice. Since the patient is the one who ultimately must deal with the horrific effects of amputation, this MENACE scale is based on patient centered factors, something that must be considered but rarely is.

Why is it important?

This article underpins the need for surgeons and others to take patient centered factors into consideration rather solely the clinical factors when considering lower extremity amputation. The skill levels for limb salvage are so wide and varied that the mentality of limb salvage should always be the most urgent actions taken with amputation doe as an absolute last choice. This MENACE scale and the issues it represents are meant to mandate that all actions be taken to avoid amputation and prolong limb presence. AT the very least, there should be attempts through referrals, "amputation Boards" and other considerations for limb salvage before amputation is proposed and more, carried out.


Dr Michael S. Miller

As an expert in limb salvage, the amputation rates under our care are significantly lower than the areas. More, we see a considerable number of patients whom have been given no alternative but lower extremity amputation for whom we provide limb preservation services that result in healing and continued lower extremity function. Unfortunately, the egos and lack of skill of far too many who encounter lower extremity wounds precludes them from realizing that there are others who can do what they are unable to but more, they they need to consider alternatives to amputation even when it means sending that patient to another "competitor".

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