Best approach for thoracic trauma is
Midline sternotomy
Parasternal thoracotomy
Anterolateral thoracotomy
Posterolateral thoracotomy
Here best option is anterolateral thoracotomy. Different approaches to the contents of the chest cavity are.. Left anterolateral thoracotomy : left lung and lung hilum, Thoracic aoa, left side of hea, origin of left subclan aery and lower oesophagus. Right anterolateral thoracotomy : Right lung and lung hilum, Azygos vein, Superior vena cava, Infracardiac inferior vena cava, Upper oesophagus, Thoracic trachea. Median sternotomy : Anterior aspect of the hea, Anterior Mediastinum, Ascending aoa and arch of aoa, pulmonary aeries and Carina of trachea. Indications for thoracotomy: 1.1000ml drained at inseion of chest drain. 2.Continued brisk bleeding >100ml per 15 min. 3.Continued bleeding >200ml per hr. for 3 or 4 more hrs . 4.Rupture of bronchus, aoa, oesophagus, diaphragm. 5.Cardiac tamponade. Reference : Bailey & love, 27th Edition, page no = 371.
Trauma