Before discussing chest wounds, it is important to emphasize that in cases of major trauma there are usually multiple injuries. No standard textbook patterns are available for study. The surgeon accepting responsibility in the care of the badly injured patient must be versatile and confine neither his interests nor his treatment to one body cavity or region. In all major injuries certain basic factors must be considered and controlled: first, adequate circulating blood volume; and, of equal importance, pulmonary ventilation or open airways, which will result in satisfactory respiration and oxygen exchange. SUCKING WOUNDS If the pleura has been penetrated and a sucking wound of the chest produced, it is usually apparent. It is important to remember, however, that if there is any possibility of an opening into the pleural cavity the clothing should be removed, even under the worst conditions, to locate the defect. The importance of prompt closure