Unstable Penetrating Chest Trauma
Annotation for Point E
Central injuries (between the midclavicular lines) and those associated with possible great vessel or cardiac injuries are best approached by sternotomy. This seems to be particularly salient in the setting of gunshot wounds.10 Supraclavicular extension will allow exposure of the great vessels.13 If the surgeon is not facile with sternotomy or if other findings (such as multiple different wounds, etc.) affect planning, an anterolateral thoracotomy with extension across the midline is perfectly acceptable and is the preferred approach for many surgeons. It is difficult to control the left inferior pulmonary vein from a transsternal approach without causing cardiac decompensation. Whichever approach is used, there should be no hesitation to extend the incision in any way needed.