Abstract: The management of military ballistic trauma of the upper extremity has evolved to reflect the advancement of military-grade ballistic weapons which continue to advance in their technology, design, and capacity to cause devastating orthopedic trauma. The early management of these injuries is critical to the eventual functional outcome of the extremity and includes battlefield tourniquet placement, damage control orthopedics, and temporary revascularization. Throughout the process of debridement, these patients are cared for by multidisciplinary teams with early consideration given to both preservation and reconstruction and soft tissue coverage.