Ballistic injuries from projectiles such as bullets and shrapnel pose significant public health challenges, particularly in the upper extremities, leading to complex reconstructive needs. This article provides an overview of soft tissue reconstruction of ballistic injuries to the upper extremity. Management involves initial stabilization, staged debridement, and subsequent reconstruction depending on the defect which can range from simple debridement and local flaps for low energy projectiles and more extensive procedures for high energy projectiles, including negative pressure wound therapy, locoregional flaps, and possibly free flaps.
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