Treatment of a combined gunshot wound with a defect of the humerus and radial nerve (clinical observation)

Treatment of patients with gunshot bone and soft tissue defects of the extremities requires non-standard approaches and the participation of doctors of various specialties. The application of additive and microsurgical technologies allows one-stage restoration of bone defects and functionally important soft tissue formations. Objective: To demonstrate the possibilities of modern reconstructive-plastic surgery in combination with additive 3D-technology in the treatment of patients with severe gunshot wounds of the extremities. Clinical case: a patient with a combined wound of the chest and upper limb with a primary defect of the humerus and radial nerve. Treatment was based on damage control surgery (DCS) and damage control orthopedic (DCO) tactics. X-ray, computed tomography, and angiography were used for diagnostics and preoperative planning. Based on the CT data, a 3D model of the autograft, resection templates, and a metal structure for osteosynthesis were made. After stabilization of the general condition of the wounded man and elimination of the risk of infectious complications, a one-stage replacement of the radial nerve defect at the level of the middle third of the shoulder with a gastrocnemius nerve autograft was performed; the upper and middle third humeral bone defect was replaced with a free blood-supplied fibula autograft with osteosynthesis using an individual 3D plate with bacteriostatic hydroxyapatite spraying in combination with zinc. А positive anatomical and functional outcome was achieved in the treatment of a patient with a gunshot defect of the humerus and radial nerve. An individual complex approach combined with innovative technologies makes it possible to achieve good anatomical and functional results in the treatment of patients with primary combined limb gunshot defects.