A clotted hemothorax should be surgically removed if it is less than 7-10 days old. Beyond that time, thoracotomy should be delayed for 4-5 weeks, after which a pleural decortication should be performed. During the decortication, care should be taken when performing the dissection where the parietal pleura reflects onto the lung posteriorly. The same problem exists when the dissection is carried into the diaphragm. If the procedure is delayed for months, the problem will be a trapped lung.
Decortication is indicated if more than the equivalent of one lobe is nonfunctional.
An infected hemothorax cannot be removed by tube drainage and will require decortication at whatever time it becomes apparent. Retained foreign bodies should be removed electively if they exceed 1.5 cm in size. Notwithstanding the experience of World War II, intracardiac foreign bodies should not be removed unless cardiopulmonary bypass is readily available. Penetrating combat trauma involving the esophagus or trachea is rare. There is suggestive evidence that small penetrating injuries, especially of the membranous trachea, maybe benign.