The effectiveness of aggressive resuscitation and early surgical intervention is evaluated in 1,992 casualties with thoracic battle wounds in Lebanon. The mechanism of injury was mainly high-velocity missiles and shelling in city battles. Ninety-seven percent of the wounds were penetrating. The mean age of the wounded was 20 years and the average transport, 4.2 km (3 miles). Logistics and newly equipped thoracic centers aided uniform therapy. For decompensating patients or those in critical condition, initial shock was treated with rapid volume expansion, cardiopulmonary support, and urgent thoracotomy. Thoracotomy was required in 1,422 casualties (71%) and definitive tube thoracostomy in 29%. Three hundred ten patients had pulmonary resections: 36 pneumonectomies, 112 lobectomies, and 162 segmental resections. In 627 patients following primary thoracotomy survival was 98.4%. For 456 casualties with additional systemic procedures, survival was 96.9%. For 285 casualties with cardiac injuries, a significant 14% incidence, overall survival was 73%. Survival was best for those with pericardial and coronary vessel wounds and dropped to 46% for those with left ventricular injuries. Survival was 87% among 54 patients with great vessel wounds. Life salvage in 726 (36%) patients was documented to result from early open procedures. Other benefits of this approach are presented in this broad-based study.