Clinical case report: management of a patient with extensive bone and soft tissue damage after a mine-blast injury

Abstract

Combat-related upper extremity trauma is one of the most frequent and severe categories of injuries in contemporary armed conflicts. Such injuries often cause extensive bone and soft tissue damage, impaired blood supply, infectious complications, and reduced limb mobility. In many cases, these problems require amputation, significantly diminishing patients’ quality of life.

This report presents the clinical management of a 35-year-old patient who sustained a mine-blast injury. The injury resulted in combined chest and right upper limb trauma, including a humeral defect and extensive soft tissue damage. Treatment progressed in stages, following principles of damage-control surgery. Interventions included pleural cavity drainage, repeated surgical wound management, vacuum-assisted closure (VAC), and stabilization of bone structures. After the patient was stabilized, we performed a reconstructive procedure using a latissimus dorsi musculocutaneous flap on a vascular pedicle to close the soft tissue defect. Subsequently, the bone defect was reconstructed using a non-vascularized fibular autograft. This approach was chosen because of extensive cicatricial changes at the injury site. The comprehensive treatment facilitated limb salvage and enabled partial restoration of mobility by preserving the elbow joint and distal segment mobility.

This clinical case shows that, even in severe mine-blast upper extremity injuries with extensive tissue damage, reconstructive interventions can be an effective alternative to amputation. Success depends on individualized treatment planning, thorough infection control, and preservation of function in the distal segments of the limb.