# Multistage microsurgical reconstruction after catastrophic shark attack: Vascularized ulnar nerve grafting for a large segmental sciatic nerve defect

## TL;DR

A woman survived a severe shark attack and regained function through a series of complex surgeries, including a novel nerve grafting technique.

## Contribution

The first reported use of a vascularized ulnar nerve graft for large segmental sciatic nerve reconstruction.

## Key findings

- Staged microsurgical reconstruction restored functional independence in a patient with catastrophic shark attack injuries.
- A vascularized ulnar nerve graft successfully repaired a 16 cm sciatic nerve defect.
- Combination of flap transfers and targeted muscle reinnervation improved quality of life.

## Abstract

We present a 48-year-old woman who sustained life threatening polytrauma from a shark attack in New Caledonia, including posterior trunk and thigh crush-avulsion, bilateral upper-limb amputations and a 16 cm segmental sciatic nerve defect. Staged reconstruction included a free latissimus dorsi (LD) flap to the posterior thigh, a vascularized ulnar nerve graft (VUNG) for sciatic repair, a neurotized anterolateral thigh (ALT) flap for sensate hand coverage, toe-to-thumb transfer and targeted muscle reinnervation (TMR). This approach achieved functional independence and quality of life restoration. This is the first reported use of a VUNG for large segmental sciatic nerve reconstruction.