Pectoralis Major muscle is the choice for reconstruction after mediastinitis in cardiac surgery. In some cases no pectoralis muscle is available or difficult to use and the Vertical Rectus Abdomis Myocutaneous (VRAM) flap is indicated. Also the VRAM flap may be used in other conditions as : postmastectomy reconstruction and radionecrosis of the chest wall. Material, patients and methods: We analyze 8 cases of reconstruction of midline and thoracic defects (mediastinitis, chronic sternal osteomielytis, breast cancer, breast reconstruction and radionecrosis of the thoracic wall) with VRAM flap Results: We obtained good results in all the cases with no failue of the flap. We report a long –term outcome with a follow up of 1-5 years Discussion: It is important to point out that some cases are difficult to manage due to local conditions of the thoracic wall and the VRAM flap is a good and easy option to perform. It has been used for reconstruction of sternal defects, particularly in the inferior third, since it was described 20 years ago. In other cases like breast reconstruction in very thin patient is a flap to consider when a contralateral breast augmentation in necessary and a Latissimus Dorsi flap cannot be used.

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