Twenty-eight patients with military crural vascular injuries are prese
nted. In the group undergoing immediate repair (21 patients), the time
interval between trauma and surgery was 20 min to 30 h (mean 8 h 30 m
in). In those receiving delayed repair (seven patients), the interval
between trauma and surgery was 3-47 (mean 14) days. Hyperbaric oxygena
tion therapy was used in conjunction with surgery and antibiotic thera
py in 13 of the 28 patients. Explosive injuries were found in 14 patie
nts and high-velocity missile injuries in nine; associated fractures w
ere present in 20. Twenty of the 28 patients with crural vascular inju
ries had combined arterial and venous injuries, while eight had isolat
ed arterial injuries. Twenty-five patients with distal ischaemia requi
red arterial repair; five late amputations resulted. Military crural v
ascular injuries should be treated with soft tissue debridement, remov
al of foreign material, and microvascular arterial and concomitant vei
n reconstruction. This should be followed by external skeletal stabili
zation for bony and/or soft tissue instability, with fasciotomy for an
y associated compartment syndrome. The wound should be left open, with
delayed closure or split skin grafting. It was felt that hyperbaric o
xygen therapy reduced the amputation rate following combat-related cru
ral vessel injuries.