In this video, we review the surgical management of lung injury, using media from our cadaveric fresh tissue dissection lab and recent patient cases. Chest trauma is common, being a component of 40% of trauma presentations. Most of these injuries, however, can be managed non-operatively with only supportive care and chest tube thoracostomy. About 15% of penetrating and 5% of blunt thoracic injury will require operation. Indications for operative management include hemodynamic instability attributable to the chest, undrainable hemothorax, persistent air leak, and high bloody chest tube output. An anterolateral thoracotomy is the incision of choice for undifferentiated lung injury. Although pneumorrhaphy may be used for peripheral lacerations, long tracts, as often seen in penetrating injury, should not be oversewn. Instead tractotomy can be used to unroof the injury giving the surgeon access to any bleeding vessels or parenchymal air leak. For more destructive injuries, wedge resection can be used in the periphery of the lung and nonanatomic lobectomy when closer to the hilum. For more devastating injuries or those involving hilar structures, pneumonectomy is the procedure of choice. This is performed by stapling across and then dividing the lung hilum, making sure to place stay sutures on either side to prevent retraction. Pneumonectomy for trauma is associated with high mortality rates, usually via right heart failure, and this must be anticipated.