Background: Upper limb trauma is one of the commonly noted limb injury in association with polytrauma. Skeletal defects are common in a combat setting due to high velocity projectiles and cavitation phenomenon caused. Reconstruction of these composite defects is difficult, and patients benefit from a single stage reconstructive modality

Aim: To assess the time taken for union, resuming activity and donor site morbidity in patients with segmental post–traumatic bony defects of the upper limb.

Methods: The study was a prospective observational study, conducted in an Armed Forces Referral Hospital from 2013 to 2015. 09 patients with segmental skeletal defects of forearm and hand were included in the study and were operated at this center. The average patient age was 31.6 years with the youngest being 18 years of age. All patients were referred to our center after an initial procedure at the nearest primary health care facility.

Results: All patients were operated by a single surgical team. 05 patients underwent free fibula flap, 01 patient underwent a split radius flap, 02 patients underwent 2,3 ICSRA based flap and  01 patient had a ‘spare parts’ surgery. Semi–rigid fixation with intramedullary nail or K wires were used and all grafts healed over an average of 10.5 months. There was significant improvement (p=0.029) in pre– and post op DASH scores in these patients.

Conclusion: Vascularised bone graft offers a single stage option for one stage reconstruction of these difficult defects. We recommend that this option should be used even in those patients who do not fit in the conventional criteria for use of vascularised bone grafts.