Dear Sir, Bone Plates; Mediastinitis; Surgical Wound Infection; Surgical Flaps; Sternum. We read with interest the recent paper by De Feo and colleagues1 on the management of deep mediasti- nitis following cardiac surgery. The authors should be commended for the comprehensive work reporting their experience of this topic over a period of thirty years. The authors analyzed different treatment modal- ities that have evolved through long clinical experience. Over the course of many years, they passed through mediastinal irrigation to granulated sugar and vacuum application, to clean the surgical wound in patients suffering from deep mediastinitis. They con- clude with: ‘‘the most reasonable management protocol is based on early surgical debridement of the wound, vacuum application, followed by plastic reconstruction with pectoralis muscle flap.’’
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