Pulmonary injuries requiring thoracotomy are uncommon. Most patients with lung injuries can be treated with a simple tube thoracostomy. Resectional procedures include non-anatomic lung resection, formal lobectomy and formal pneumonectomy. Non-anatomic lung resection is indicated for control of hemorrhage, control of air leaks and resection of destroyed lung tissues. Lobectomy and pneumonectomy are indicated for control of major air leaks, and control of life-threatening hemorrhage. The high mortality rates reported for pneumonectomy when performed after traumatic lung injury. Video-assisted thoracoscopic surgery (VATS) also has been demonstrated to be a reliable operative therapy for lung injury. Surgical treatment of traumatic pulmonary injuries requires knowledge of multiple approaches and operative interventions.