Figure 6 Reconstruction of the wound with the free rectus abdominis muscle flap: Line drawing illustrating the free rectus abdominis muscle transfer for thoracotomy wound reconstruction: The right internal mammary artery and vein were anastomosed in an end to end fashion to the right deep inferior epigastric artery and vein, respectively. IMA/V: The check details internal mammary artery and vein, DIEA/V: The deep inferior epigastric artery and

vein, EIA/V: The external iliac artery and vein, R: The rectus abdominis muscle, S: The sternum, F: Fascial closure. Figure 7 The free rectus muscle transferred to the wound: The free rectus abdominis muscle flap transferred to the wound. The right internal mammary vessels extending from the third to fourth intercostal space were prepared for microvascular anastomoses after removal of the third cartilaginous rib. Figure 8 The inset of the rectus muscle: The right chest incision in the recipient site was closed and the free rectus

muscle flap was inset. Figure 9 Postoperative picture: Two months after the reconstruction. Discussion Wound complications associated with emergency thoracotomy have not been reported in the literature. In light of the almost non-existent infection rate, surgical debridement and the reconstruction of EDT wounds is rarely necessitated. The management of the complicated EDT wound was initiated Rolziracetam by adequate surgical debridement and appropriate antibiotic treatment prior to definitive reconstruction. In addition, coverage especially with a muscle flap was planned to overcome Ipatasertib nmr the infection and to supplement the healing in such a wound with exposed heart. The pectoralis major, the latissimus dorsi, the rectus abdominis,

and omental flap are most frequently employed flaps in the chest and sternal region wound reconstruction [3, 4]. However, in our case, reconstruction of the thoracotomy wound presented several reconstructive challenges. The pectoralis major or latissimus dorsi muscle flaps were not suitable with regards to the location of the EDT wound. The omental flap was not employed to avoid laparotomy and associated risks. On the other hand, the rectus abdominis muscle could not be utilized since the superior epigastric vessels, the pedicle of a superiorly based flap, were found to be unreliable. The superior epigastric artery originates from the internal mammary artery at the level of the seventh rib. Then, it descends between the costal and xiphoid slips of the diaphragm, anterior to the lower fibers of the transversus thoracis and transversus abdominis. Entering the rectus sheath, at first behind the rectus abdominis muscle and then perforating and supplying it, it anastomoses with the deep inferior epigastric branch of the external iliac [5] (Figure 4).