What question did this study set out to answer?

The aim is to present a novel approach to repair a large segmental sciatic nerve defect using vascularised ulnar nerve grafting.

February 23, 2026Open Access

Multistage Microsurgical Reconstruction After Catastrophic Shark Attack: Vascularised Ulnar Nerve Grafting for a Large Segmental Sciatic Nerve Defect

Key Points

The aim is to present a novel approach to repair a large segmental sciatic nerve defect using vascularised ulnar nerve grafting.
Performed staged reconstruction using various surgical techniques.
Utilized a free latissimus dorsi flap for posterior thigh reconstruction.
Applied a vascularised ulnar nerve graft for sciatic nerve repair.
Implemented a neurotised anterolateral thigh flap for sensory coverage.
Executed a toe-to-thumb transfer and targeted muscle reinnervation.
Achieved functional independence post-surgery.
Significantly improved quality of life.
Demonstrated the first use of vascularised ulnar nerve graft for large nerve reconstruction.

Abstract

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 16cm segmental sciatic nerve defect. Staged reconstruction included a free latissimus dorsi (LD) flap to the posterior thigh, a vascularised ulnar nerve graft (VUNG) for sciatic repair, a neurotised 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.

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Cite This Study

Bishay et al. (Sun,) studied this question.

synapsesocial.com/papers/699bee551c6c6bad5397fefe https://doi.org/https://doi.org/10.1016/j.jpra.2026.02.016

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