An example of an emergency left anterolateral thoracotomy for a gunshot wound to the chest is shown. This incision is also the first choice for when emergency room thoracotomy is done for sudden collapse or cardiac arrest.
If initial exploration through a left anterolateral thoracotomy shows the need for additional exposure, the incision can be extended across the midline using sternal saw, Lebsche knife or Gigli saw to create a bilateral anterolateral thoracotomy (clamshell incision). The internal mammary arteries must be ligated. This incision is rarely used in a trauma setting anymore, and has been questioned as the standard for bilateral lung transplant because of the associated morbidity.
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