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JCTCV:21(1), Objective: Sternal OsteoRadioNecrosis (ORN) is an uncommon complication that may occur several decades after thoracic radiation therapy. For severe lesions with skin ulceration, radical treatment by resection of ORN and coverage with a flap can be proposed. We report herein our experience of sternal ORN treatment with an omental flap. Methods: Retrospective analysis from January 2005 and December 2015 of all patients with ulcerated ORN. Results: Thirteen patients with a median age of 69.2 years were treated for an extended sternal ORN. Median interval between radiotherapy and treatment was 30 years. After elective cutaneous and sternal resection, the omentum was removed by a supra-umbilical median incision, pediculated over the right gastroepiploic artery and subcutaneously translated to cover the parietal defect. The chest wall healing was achieved in all patients with no mortality. Partial necrosis of the flap was noticed in 2 patients with a good evolution with local treatment. One case of eventration required a surgical cure in the follow-up. Conclusions: After elective sternal resection for severe ORN, the omental flap offers an efficient and simple coverage allowing complete healing in all patients. Angiogenic and immune abilities of the omentum make it the flap of choice for the coverage of sternal ORN.