The extrathoracic muscle flaps can be used in a number of different situations such as in sternal reconstruction, for filling many types of defects, and in chest wall reconstruction. The extrathoracic flaps can be utilized in the treatment of postpneumonectomy empyema and bronchopleural fistula after lobectomy. Another use for these flaps is in tracheal resection as coverage of an anastomotic area and in the gastrointestinal tract as wrapping for an anastomoses. After repair of certain defects in the heart and great vessels, they may be used to wrap the heart or the great vessels; they may also be used in total sternal reconstruction and in the treatment of postoperative open heart mediastinitis. A thorough knowledge of the extrathoracic muscle flaps is a prerequisite in the training of any cardiothoracic surgeon.