Single-Stage Reconstruction of a Devastating Antebrachial Injury With Brachial Artery, Median Nerve, and Soft Tissue Deficit: A Case Report and Review of the Literature

OBJECTIVE We present a case of a 31-year-old man who fell through a skylight sustaining a deep laceration injury to his dominant arm. A single-stage radial artery flow-through free flap and cabled sural nerve graft for reconstruction of a complex antebrachial defect involving skin, soft tissue, muscle, brachial artery, and median nerve was performed. A technical description of the case and review of the literature are described. METHODS Traumatic injuries to the arm and antecubital fossa often lead to devastating outcomes. Advances in microsurgical technique as well as improved skin and dermal substitutes have allowed improved outcomes as well as shorter hospital stays. In this case, surgical treatment involved microsurgical reconstruction of the brachial artery with a radial artery flow-through flap and a single-stage donor-site closure with an Integra dermal matrix template and split-thickness skin graft. RESULTS Successful vascular flow and soft tissue coverage were performed with successful salvage of the limb. CONCLUSION A single-stage reconstruction versus a multistage, delayed reconstruction of a devastating arm injury with a radial forearm flow-through flap and single-stage closure with Integra and autologous skin graft can provide a safe, effective, and clinically satisfactory outcome.