Reconstructive surgery in major vein injuries in the extremities.
1) In major vein trauma, an attempt should be made to repair the vein. 2) Whenever possible, lateral suture seems to be the ideal type of repair. However, excellent results can be obtained with end-to-end anastomosis. 3) When the damaged segment of the vein is too long to permit end-to-end approximation, a vein interposition graft (and if necessary, a composite tube) appropriate to the width of the injured vein and length of the gap should be employed. Use of synthetic grafts should be avoided. 4) Although the importance of a distal temporary A-V fistula is still disputed, the present authors have adopted this method in the graft repair of the femoral vein in the groin. Better results were obtained in the cases in which the fistula functioned than in those in which it became occluded.