Trap door incisions

The left-sided trap door (A) is the classic approach to the left subclavian region. To provide exposure of the right subclavian region, an upper sternotomy with a right supraclavicular extension (B) can be used, particularly in the setting of trauma. For the innominate artery, a full sternotomy provides more reliable exposure. A right-sided trap door (C) is useful in elective surgery, providing optimal exposure of the right upper chest (eg, Pancoast tumor resection).