Formal chest operations other than minor procedures are required by only 12 to 15 per cent of patients with thoracic trauma. For those patients requiring thoracotomy, the operation may be required acutely or on a delayed basis. Acute thoracotomy may be necessary urgently, but in most situations, it is performed after a systematic evaluation has revealed specific symptoms and proved injuries. Some conditions should NOT lead automatically to thoracotomy unless other indications for the operation are present. In some cases, thoracotomy is required on a delayed basis.