Rectus abdominis flap for chest wall reconstruction

The rectus abdominis can be transferred as a muscle or as a musculocutaneous flap from the lower abdomen, with vertical or transverse skin orientation. A transverse orientation provides a larger, but less reliably vascularized, cutaneous flap. Following internal thoracic artery ligation (eg, prior coronary artery bypass grafting), the rectus abdominis muscle may still be well perfused through the musculophrenic artery and through the lower intercostal arteries upon which the flap can be based.