Penetrating vascular injury which is associated with a satisfactory response to treatment occurs more commonly than blunt injury in the upper limb. Blunt trauma is a complex entity with associated soft tissue and skeletal injuries that may determine outcome irrespective of successful vascular repair. We reviewed 50 patients with upper limb vascular injury of which 43 were due to blunt trauma and seven to penetrating trauma. All patients with penetrating trauma had a good result without loss of limb function. Eight amputations and residual poor limb function in ten patients confirm the poor results of blunt injury. Associated nerve damage, responsible for nine of the ten poorly functioning limbs, is the most important determinant of outcome in limbs surviving the peri-traumatic period.