Fig. 16.

Photograph showing the patient positioned for the surgical procedure in a left decubitus position on a beanbag and axillary roll with the right arm in abduction. A double lumen endotracheal (ET) tube is seen. A lateral approach is marked as a curvilinear skin incision (red). If required, “lazy-S” extensions (black) may be added for access to the high-posterior and low-anterior rib fractures. Anatomical landmarks are noted (scapula and spinous processes). The operating table is flexed to 15°. An initial 36 French gauge chest tube (placed in the trauma bay) is to be removed before the incision and replaced with a new chest tube (in a new location) at the end of the procedure. The lateral abdominal hematoma does not indicate the epicenter of the rib fractures. The large hematoma includes the iliac crest area.