This video discusses the operative management of upper limb vascular trauma. Patients who present with ‘hard signs' of vascular trauma warrant operative management. This patient presented with absent radial/ulnar/brachial pulses following a fall in which he sustained a fracture to his left humerus. This 7 minute video describes the operative approach for adequate exposure and repair of the axillary artery following blunt trauma. An infraclavicular incision is used and can be extended into the delto-pectoral groove. Pectoralis major muscle fibres are spit in a grid iron fashion and pectoralis minor divided to reveal the second part of axillary artery. The vessel is controlled both proximally and distally before the injured segment is examined, excised and repaired. It is important to note that for more proximal injuries i.e the subclavian artery, a separate supraclavicular incision may be required to control the subclavian artery with or without division and excision of the clavicle, and the surgeon should be familiar with this approach. Options for surgical repair in vascular trauma include primary end-to-end anastomosis of the native vessel, interposition vein/prosthetic graft or damage control manoeuvers including temporary shunt, ligation or primary amputation. Following fixation of his fracture an interposition vein graft repair was performed using the cephalic vein. A completion angiogram confirmed flow was restored to the left upper limb. The patient had an uneventful recovery.