Free Functional Muscle Transfer and One Bone Forearm for Upper-Extremity Limb Salvage After High-Energy Ballistic Trauma

Upper-extremity limb salvage following high-energy trauma poses unique challenges of massive soft tissue injury in the setting of large bone defects, traumatic segmental neurovascular injuries, and functional deficits. These complex injuries require multidisciplinary care to achieve requisite revascularization, bone stabilization, and preservation of remaining options for soft tissue coverage. This case presents a 45-year-old man who sustained a high-velocity gunshot resulting in a dysvascular limb. Through shared decision-making, upper-extremity limb salvage was pursued. Successful initial limb salvage included a reversed great saphenous vein graft from the brachial artery to the radial artery, followed by one bone forearm with nonvascularized graft from the ipsilateral distal ulna, latissimus dorsi free functioning muscle transfer with an end-to-side anastomosis to the brachial artery proximal to the vein graft, and coaptation of the anterior interosseous donor nerve from the proximal median nerve stump to the thoracodorsal recipient nerve.