Thoracic approaches and incisions

Jeffrey A. Bailey, Philip S. Mullenix, Jared L. Antevil

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


Don't confuse war surgery with elective thoracic practice. You need simple, reproducible, feasible, and fast solutions set in your mind for the various scenarios. Always prep your patients for the maximum, and be flexible after you make your initial move. Think about the compartments - where is the bleeding happening now? Be paranoid about the other compartments until you clear or control them one way or another. Never be afraid to extend your incision or make one somewhere else. For precordial wounds without pleural hemorrhage, think about a sternotomy. For inadequate exposure after anterolateral thoracotomy or suspected right pleural space hemorrhage, move to clamshell. Proximal left subclavian artery injuries are notoriously challenging, but a high left anterior thoracotomy is a key first move. Reserve posterolateral thoracotomy for delayed problems in stable patients with isolated unilateral chest trauma. No matter what the situation is, remember that you have within you the courage, intellect, audacity, perseverance, and proper training, and you will save your patient. And if all else fails, left anterolateral thoracotomy is a good place to start.

Original languageEnglish
Title of host publicationFront Line Surgery
Subtitle of host publicationA Practical Approach
PublisherSpringer International Publishing
Number of pages21
ISBN (Electronic)9783319567808
ISBN (Print)9783319567792
StatePublished - Jul 21 2017


  • Chest incisions
  • Clamshell
  • Initial management
  • Sternotomy
  • Thoracic trauma
  • Thoracotomy
  • Trapdoor
  • War surgery


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