Penetrating neck injuries are a crucial area of trauma care and represent nearly 5–10% of all trauma cases in the emergency department. Injuries in the zones 1 and 3 of the neck are more difficult to investigate than zone 2 and require extensive effort and knowledge. We report the case of a 35-year-old male patient with penetrating neck injury in zone 1 of the neck, causing left-sided hemothorax. Effective patient management was challenging as the patient was unstable and could not be transferred to any nearby tertiary hospital. Therefore, he was immediately transferred to the operative table. A longitudinal neck incision was made on the left side of the neck to control the bleeding, and median sternotomy in addition to anterior thoracotomy was performed. Two injuries were observed at junction of the jugular, subclavian, and brachiocephalic veins, and one injury was seen in a side branch of the subclavian artery. The patient was treated successfully through this treatment approach, thereby overcoming the challenges of a complicated case and limited facilities in the hospital.