Gunshot upper extremity injury reconstructed with a fibula osteoseptocutaneous free flap (case report)

The management of upper extremity gunshot wound with soft tissue and bone injuries remains a remarkable problem and often requires sophisticated reconstructive strategies.There are limited reconstructive options for the treatment of segmental bone defects of the upper extremity exceeding 6 cm in length, especially when associated with soft tissue loss. Among the limited treatment options, the osteoseptocutaneous fibular transplantation is well established. The vascularized fibula flap has become a major tool in upper limb reconstruction but still is an uncommon procedure and continues to challenge reconstructive surgeons.In this paper, we report a complex combined skeletal and soft tissue involvement of an upper extremity case successfully treated with fibula osteoseptocutaneous free flap. The bone defect measured 12 cm. In severe injuries of the upper extremity, free transfer of the fibula flap not only provides replacement of the resulting composite defect but may also offer salvage of the extremity.