Abstract: Objective：To investigate the feasibility of using rectus abdominis flaps harvested by video-assisted endoscopy in the treatment of thoracic defects after surgical debridement for deep sternal wound infection (DSWI). Methods：The clinical data of 5 patients with DSWI were analyzed retrospectively. All 5 patients underwent surgical treatment. Total sternums or most of the sternums were resected, and partial cost cartilages were removed, and the bilateral pectoralis major were partial dissociated. Then the thoracic defects were reconstructed with the rectus abdominis flaps and pectoralis majors by one stage, 2 of 5 patients’rectus abdominis flaps were harvested by video-assisted endoscopy. The operation results and postoperative complications were observed. Results：All 5 patients were healed primarily without significant complications. Two patients with rectus abdominis flaps harvested by video-assisted endoscopy had decreased operation wound, and the operation time was not obviously extended. Follow-up for 1 to 12 months showed that all 5 patients had no pain, no recurrence of infection, no abdominal incisional hernia, and their respiration function improved significantly. Conclusions：Rectus abdominis flap is a good choice for the repair of sternal wound of patients who suffered from the extensive thoracic defects after deep sternal wound infection. The treatment with video-assisted endoscopy shows superior results, it can reduce the abdominal invasiveness and postoperative pain, improve abdominal respiration, and accelerate recovery.