Sternal wound closure using the rectus abdominis muscle in spite of a subcostal scar

Although median sternotomy wound complications are uncommon, the consequences can be potentially devastating. The superior-based rectus abdominis muscle is an important complementary flap that is especially valuable to obliterate the inferior aspect of these extensive wounds. This is not usually possible with the workhorse pectoralis major muscle alone. The increasing use of the internal mammary arteries as a bypass conduit or a prior subcostal scar may devascularize the rectus abdominis muscle and, thus, are relative contraindications for selecting this muscle. However, depending on the size of the defect and location of the subcostal scar, the upper portion of the rectus abdominis muscle may, at least, still be a viable and important alternative flap.