Trap-door thoracotomy as an ideal access route for internal cardiac massage and repair of subclavian vessels

Introduction: subclavian vessel injuries remain rare and highly lethal. Patients with these types of injuries can present with neck and upper chest hematoma, hemorrhage, and signs of upper limb ischemia. Trap-door thoracotomy allows wide exposure of the thoracic cavity and base of the neck, providing rapid access to the heart, subclavian vessels, pulmonary ileus, and other anterior mediastinal structures. Objective: to describe the trap-door thoracotomy as the ideal approach for internal cardiac massage and subclavian vascular repair in hemodynamically unstable patients. Cases presentation: two patients with severe subclavian artery injuries are presented. They underwent emergency surgery using a trap-door thoracotomy, where bypass was performed from the ascending aorta to the left axillary artery with a polytetrafluoroethylene prosthesis in the first case and bypass from the left carotid artery to the left subclavian artery with an inverted saphenous vein in the second patient. Conclusion: the trap-door thoracotomy allows optimal access to the subclavian vessels and the heart if cardiopulmonary resuscitation is needed in critically ill patients.