Management of complex vascular injuries to the extremities.

Complex vascular injuries to the extremities are challenging and, to this day, continue to cause significant morbidity and tax the ingenuity of the vascular surgeon. we have presented complicating factors and conditions that may jeopardize a successful outcome. Distal ischemia and limb loss may be caused by conditions other than arterial injury. Venous repair for major venous injury, decompression fasciotomy in compartmental hypertension, early recognition and management of associated vascular injuries in fractures and dislocations, sensible use of arteriography and venography, and prevention of postoperative wound infection by radical debridement and adequate wound coverage for close-range shotgun wounds and replanted limbs are some of the important features that will aid in successful efforts to preserve the anatomy and function of the traumatized limb.