Thoracic injuries are considered to be one of the most severe injuries of human systems and organs, which are characterized by a large number of complications and high mortality. According to the ATO data in eastern Ukraine, the frequency of chest injuries in the general structure of combat surgical injuries is 11.7%, the overwhelming majority of which were non-penetrating injuries (83.6%). The overall mortality rate for penetrating wounds of the breast is 5–10%. Surgical tactics for injuries and injuries of the chest is diverse and depends on the type of traumatic injury, the time of first medical and specialized care, the severity of the condition of the victims, the presence of complications, the technical capabilities of the hospital. Objective: optimization of surgical tactics for wounds and injuries of the chest through the use of video-assisted thoracoscopic techniques. A retrospective analysis of the surgical treatment of 103 thoracic wounded and injured, which were located in the Military Medical Clinical Center of the Southern Region in Odessa and the area of responsibility (level II–IV medical care) from June 2014 to July 2017, was carried out. At the stages of medical evacuation of all 103 thoracic wounded and injured in most cases (41 people (39.8%)), drainage of the pleural cavity was sufficient to eliminate hemo- and pneumothorax — 25 (24.3%) underwent various surgical interventions from thoracotomic approaches, 16 (15.5%) had various video-assisted thoracoscopic surgeries, 16 (15.5%) had only surgical treatments for gunshot wounds, and 5 (4.9%) wounded and injured had only conservative therapy. Conclusions: Promising, in our opinion, can be the widespread introduction of video-assisted thoracoscopic interventions into the practice of surgeons who are involved in the ATO, followed by a multicenter assessment of the results.