Transmanubrial L-shaped mini-sternotomy for vascular repair in hemodynamically stable Zone i neck injuries

Penetrating neck injuries in Zone I that involve thoracic outlet structures are rare but carry significant risks, including major airway compromise and massive hemorrhage. Exposure of vascular structures in the thoracic outlet is challenging and typically achieved through median sternotomy for right-sided injuries and left thoracotomy for left-sided injuries. These approaches are familiar to most trauma surgeons, but they may be overly invasive and unnecessary in hemodynamically stable patients. To date, less invasive alternative surgical approaches for Zone I neck injuries requiring thoracic outlet exposure have been rarely reported. Here, we present a transmanubrial approach mini-sternotomy using an osteomuscular-sparing L-shaped incision for a penetrating Zone I neck trauma with vascular injuries proximal to the left internal jugular vein and left common carotid artery. This approach enables incision extension either downward toward the sternum or laterally toward the clavicle to provide additional exposure, based on the injury location. It preserves postoperative function by avoiding unnecessary sternoclavicular joint disruption and warrants consideration in neck vascular injuries involving the thoracic outlet. LEVEL OF EVIDENCE Level VI.