Intercostal artery-based rectus abdominis transposition flap for sternal wound reconstruction: fifteen-year experience and literature review.

The rectus abdominis transposition (RAT) flap is a well-accepted alternative to pectoralis muscle flaps for sternal reconstruction after debridement in poststernotomy mediastinitis. Use of this flap based on an intercostal artery pedicle, after division of the ipsilateral internal mammary artery (IMA), is a less-recognized option for reconstruction, given its less substantial vascular supply. The authors present 15 cases where intercostal artery-based RAT flaps were used for sternal reconstruction over a span of 15 years. They describe patient demographic data, management approaches, surgical techniques, and clinical outcomes. Perioperative flap survival and wound healing was optimal in all cases. One morbidity and 1 mortality were encountered in patients with multiple chronic medical problems. Follow-up demonstrated optimal surgical results and satisfied patients. Our observations suggest that the intercostal artery-based RAT flap is a safe treatment option for sternal reconstruction when pectoralis muscle flaps have failed or do not adequately provide coverage of sternal defects after debridement of the poststernotomy wound.