Staged Reconstruction of a Complex Zone 3 Injury Involving Neurovascular and Tendon Repair

We present a case of a 67-year-old male who sustained a complex glass injury to the right palm involving Zone 3. Intraoperative exploration revealed full-thickness lacerations of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons to all four fingers, a 22 mm median nerve gap requiring cabled nerve allograft repair, laceration of the deep motor branch of the ulnar nerve and fourth common digital nerve requiring conduit-assisted repairs, and a segmental laceration of the ulnar artery requiring microsurgical reconstruction. The patient underwent staged reconstruction over two operations, including tendon repairs, nerve grafting with cabled decellularized frozen nerve allograft, vascular repair, and soft tissue coverage with adjacent tissue transfer. This case highlights the complexity of Zone 3 hand injuries and underscores the importance of staged surgical decision-making, nerve reconstruction strategies, and prioritization of neurovascular and tendon repair in high-impact penetrating glass trauma. The patient provided written informed consent for publication of all clinical details and images.