Rectus abdominis muscle transposition (RAMT) flaps can be successfully used for coverage of sternal defects caused by mediastinitis in poststernotomy patients. Information regarding abdominal wall morbidities associated with the use of this particular flap is scarce. We hereby present a rare case of spontaneous rupture of the posterior rectus fascia leading to bowel evisceration in a patient who had previously undergone sternal reconstruction with a RAMT flap. We hypothesize that certain high-risk factors present in this patient, such as morbid obesity, inadequate nutrition, and chronic cough may have had a direct impact on the integrity and strength of the abdominal wall after surgery, eventually leading to evisceration. Based on recent studies, we also suggest the consideration of allograft reinforcement to the abdominal wall fascia after RAMT flap elevation in high-risk patients, even in the presence of a concomitant infection.
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