Unstable Penetrating Chest Trauma

Annotation for Point G

Injuries lateral to the midclavicular line or deemed to be outside the ‘‘peristernal’’ area are best approached by anterolateral thoracotomy. The decision of what constitutes a ‘‘lateral’’ injury varies between surgeons, and both of the criteria mentioned earlier are acceptable. If bilateral injuries are present and there is one surgeon, the anterolateral thoracotomy should be onthe sidewhere the most bloodloss is suspected or documented. This can be converted to a clamshell thoracotomy as needed. The incision should be at approximately the third or fourth intercostal space. This is best found by making the incision in the true inframammary crease. A common error is to start an anterolateral incision that does not curl up sufficiently, resulting in crossing the sternum inferiorly. This inhibits exposure and healing.