Traumatic vascular injuries of the lower extremity most commonly involve arterial structures or occur in conjunction with significant musculoskeletal trauma. In contrast, isolated venous injuries are rare and likely underreported. Venous trauma encompasses a spectrum of injury severity, ranging from minor intimal disruption to complete transection of the vessel wall, involving the endothelium, media, or adventitia. Two primary mechanisms of injury include blunt and penetrating trauma. Penetrating mechanisms, such as stab or gunshot wounds, typically result in direct vessel laceration with partial or complete transection. Blunt trauma, such as contusion, may disrupt vessel wall integrity, ranging from intimal injury to complete disruption.

Venous trauma is less frequently associated with limb- and life-threatening complications compared with arterial injury. Peripheral venous injury may result in significant hemorrhage, hematoma formation, and soft tissue compromise, whereas arterial injury carries a higher risk of regional ischemia, pulsatile hematoma, and shock. The management of arterial injuries is well established and often requires urgent surgical intervention; however, the optimal management of isolated venous injuries remains less clearly defined.

Traditionally, superficial veins are considered expendable and are often managed with ligation. However, the great saphenous vein (GSV), despite its superficial location, is a large-caliber vessel commonly used for bypass grafting and therefore has important physiologic and surgical significance. Most reported cases of GSV rupture are spontaneous and associated with chronic venous insufficiency or varicosities rather than trauma. ^,

We present a case of a 57-year-old male with an isolated traumatic rupture of the GSV resulting in a large hematoma, hemorrhagic anemia, and subsequent soft tissue loss requiring staged limb salvage procedures.