Purpose: Traditionally used for lower sternal defects, we highlight the omental flap as a salvage option for extensive mid-to-lower sternal defects. This is crucial for patients with bilateral internal mammary artery (BIMA) harvest, where poor vascularity and lack of local flaps preclude standard reconstruction. Methodology: A 45-year-old female presented with a 6x12cm intractable sternal dehiscence extending from the middle to the lower sternum, two months after CABG. Initial reconstruction with a pectoralis major flap had failed. Due to the prior BIMA harvest, sternal perfusion was critically poor, and other local options were anatomically restricted. As a salvage procedure, we performed a laparoscopic omental harvest based on the right gastroepiploic vessels. The flap was transposed to obliterate the dead space and covered with a split-thickness skin graft (STSG) over an acellular dermal matrix (ADM). Results: The omental flap successfully provided robust vascularized tissue to the ischemic wound bed. Complete closure was achieved by 3 months postoperatively. At the 1-year follow-up, the chest wall remained stable with a favorable outcome. An asymptomatic, reducible epigastric hernia was noted at the donor site and managed conservatively. Conclusion: This case demonstrates that the indication for omental flaps can be effectively extended to cover larger defects involving the middle sternum, beyond traditional lower sternal boundaries. Clinically, it serves as an essential salvage strategy for BIMA patients who have exhausted standard reconstructive options, providing reliable coverage where other flaps fail. References 1. Villa MT, Chang DW. Muscle and omental flaps for chest wall reconstruction. Thorac Surg Clin 2010;20:543-50. 2. Kreutz-Rodrigues L, Gibreel W, Moran SL, et al. The utility of the omentum flap for complex intrathoracic problems. Plast Surg (Oakv) 2023;31:17-23.