Penetrating vascular trauma in children is most commonly seen in warti
me settings or more recently as a result of attempts at invasive imagi
ng. Treatment of these patients can be more complicated than treatment
of trauma in adults and must include maintenance of symmetric limb gr
owth, compensatory growth of the vascular graft and its anastomoses, a
nd the need for very long-term graft patency. This report describes th
e care of a 5-year-old child who was impaled by a hot metal pipe and s
ustained a penetrating thermal injury to the distal external iliac art
ery and vein. Issues such as conduit choice, extraanatomic reconstruct
ion, anastomotic suture technique, and soft tissue coverage are review
ed in the report.