As the possession of guns is strictly regulated in Japan, gunshot wounds are rare in daily medical practice. However, gunshot wounds, especially those sustained at high speeds, such as by rifles, can cause extensive tissue damage and be difficult to treat. We report the case of an extensive hand tissue defect due to the miss-shot of a rifle. Gunshot wounds on the limbs have been reported to have a higher infection rate than those at other sites. Initial treatment for gunshot wounds requires foreign body removal and debridement to prevent infection and lead poisoning. Fractures due to high speeds require a longer time for bone fusion than normal fractures. Due to the high risk of infection, tissue filling and internal fixation in fractures should be performed during a secondary surgery. We reconstructed an extensive hand tissue defect using a free fibula flap. The patient can pinch with the thumb and index finger, and is satisfied with the outcome.
