In the past 10 years, there has been a surge in the number of violent crimes associated with firearm usage. Gun-related assaults, robberies, and murders have risen by 59 percent since 1987. Penetrating trauma accounts for up to 82 percent of all vascular injuries to the extremities. Gunshot and shotgun wounds account for nearly 65 percent of penetrating vascular extremity injuries, and stab wounds account for approximately 15 percent. Of patients presenting with gunshot wounds, 20 to 40 percent have extremity involvement, either isolated or in combination with other injuries. In 1950, a patient with a penetrating extremity injury with vascular involvement had a 50 percent chance of leaving the hospital with an amputated limb. With recent advances in emergency care, vascular surgery, invasive radiology, and the science of thrombosis, penetrating extremity injury results in amputation in fewer than 5 percent.1 Despite this improved diagnosis, there is still a 15 to 40 percent long-term morbidity due to other complications, such as nerve damage, fractures, wound infections, open joint injuries, and compartment syndromes. 2

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