Flail chest occurs by blunt chest trauma and is associated with pulmonary contusion, atelectasis, pneumothorax, hemothorax, and respiratory failure. Because of its severity, it may need internal pneumatic stabilization or surgical fixation. Some patients do not need the internal stabilization and are observed conservatively. Some of these patients, however, increase the flail after palliating the pain and getting up. These patients show inefficient ventilation and surgical fixation is needed. The operation should be performed after the improvement of pulmonary contusion. In this paper, we presented 2 patients who showed such course and clarified the surgical methodology.