Reconstruction and BurnsIntercostal Artery–Based Rectus Abdominis Transposition Flap for Sternal Wound Reconstruction: Fifteen-Year Experience and Literature ReviewJacobs, Baruch MD, FACS; Ghersi, Marcelo M. MDAuthor Information From the Department of Plastic Surgery, Mount Sinai Medical Center, Miami Beach, FL. Received March 9, 2007, and accepted for publication, after revision, April 13, 2007. Reprints: Marcelo M. Ghersi, MD, Mount Sinai Medical Center, Department of Surgery, 4300 Alton Road, Suite 2240, Miami Beach, FL. E-mail: email@example.com. Annals of Plastic Surgery: April 2008 - Volume 60 - Issue 4 - p 410-415 doi: 10.1097/SAP.0b013e318070c6fb Buy Metrics Abstract 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. © 2008 Lippincott Williams & Wilkins, Inc.