The see more surface of the Birinapant supplier muscle flap was skin grafted. The flap took successfully and the patient healed without further complications (Figures 7, 8, and 9). Figure 1 Thoracotomy wound: The thoracotomy wound after a serial debridement of
soft tissue, rib cartilage and bone, and the sternum. Figure 2 Right sagittal CT angiography: CT angiography (right sagittal section) performed for preoperative planning revealed interruption of the continuity of the right internal mammary vessels proximal to the surgical clip (arrow) at the level of the right seventh rib. Figure 3 Left sagittal CT angiography: Preoperative CT angiography, left sagittal section also showed interruption of the continuity of the left internal mammary vessels proximal to the surgical clip (arrow) at the level of left fifth-seventh rib. Figure 4 The anatomical illustration of the rectus abdominis muscles, the superior epigastric artery, the internal mammary artery, and the deep inferior epigastric artery: Line drawing that illustrates the anatomy of the rectus abdominis
check details muscles, the superior epigastric artery, its relation with the internal mammary artery, and the deep inferior epigastric artery. The superior epigastric artery originates from the internal mammary artery at the level of the sixth and seventh rib. It then descends to enter the rectus sheath, at first behind the rectus abdominis muscle and then anastomoses with the deep inferior epigastric branch of the external iliac. IMA/V: The internal mammary artery and vein, SEA/V: The superior epigastric artery and vein, M: The musculophrenic branch, 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. Note that on the right side, the ribs have not been drawn
to illustrate the course of the internal mammary vessels and their branching into the musculophrenic and the superior epigastric artery and vein. Additionally, the most proximal parts of the rectus abdominis muscles and first ribs on both sides have not been illustrated. Figure 5 The anatomical illustration 2-hydroxyphytanoyl-CoA lyase of the IMA/V, the DIEA/V and SEA/V in the actual patient: Line drawing to illustrate the anatomy of the IMA/V, the DIEA/V and SEA/V in the actual patient who underwent emergency thoracotomy with bilateral transection of the internal mammary vessels (arrow heads) prior to branching into the musculophrenic and the superior epigastric branches. Removal of the forth rib and preparation of the right IMA/V, DIEA/V and ligation of the right SEA/V for harvest of the rectus abdominis muscle for free transfer have been illustrated.