PMC5217140_01
(a) Wound over the anterior chest wall after debridement; (b and c) dimension and elevation of the vertical rectus abdominis myocutaneous flap
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F1
The whole sternum including right sternoclavicular joint and the right second, third, and fourth ribs along with their costochondral junctions was exposed [Figure 1a]. A superiorly based, left-sided, VRAM flap was planned [Figure 1b]. After skin incision, rectus sheath was incised exposing the rectus muscle; the muscle was then divided near its lower end and the deep inferior epigastric vessels were ligated [Figure 1c].
(a) Vertical rectus abdominis myocutaneous flap over the chest and abdomen closed primarily, (b) patient after 2 months on follow-up visit
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F2
It reached up to right sternoclavicular joint, effectively covering the whole of the sternum, exposed second, third, and fourth ribs on the right side and exposed intercostal spaces along with the rents therein [Figure 2a]. After 2 months, the patient came on follow-up visit when we found the flap, its donor site, and the skin-grafted areas completely healed [Figure 2b].