[Venous trauma of the limbs]

Traumatic lesions of veins in the limbs must be considered in 3 types of circumstances: (1) Extensive injuries, open or closed, affecting the principal vascular axis and usually damaging both the vein and artery at the same time; these wounds or ruptures in the principal venous supply pose the problem of repair using autogenous venous material, since it is now known that the result of arterial reconstruction (which is so essential for the limb) may be compromised by the lack of a satisfactory return circulation. Because of this, amputation may be resorted to, as is still too often seen in the case of the popliteal fossa. (2) Lesions of the collateral veins: these remain the most frequently encountered in civil practice; they result in either deep hematomas in the muscles (sub-aponeurotic), or superficial hematomas between aponeurosis and integument. The former may be a factor in compartment syndromes with the risk of irreversible ischemia in a muscular compartment if aponeurotomy is not carried out very rapidly, while the latter can give rise to skin necrosis if they are not drained in time. (3) Limited wounds affecting vein and artery, which are in contact, with formation of an arteriovenous fistula which may only be recognized after a certain delay if it is not systematically borne in mind. The question of assessing the sequelae over the medium and long term is raised in all cases; in the vast majority of cases, these correspond to a picture of post-traumatic thrombophlebitis. Correct preventive and curative treatment can lessen the disabling nature of the sequelae and especially their professional repercussions.