Reconstruction after median sternotomy infections is a difficult problem. We have presented ten consecutive patients with a wide variety of underlying cardiac illnesses who have had this dreaded complication develop. All of these patients have undergone successful reconstruction after adequate debridement and elimination of the mediastinal dead space using a combination of well vascularized omentum and pectoralis major muscle flaps. Stability of the chest wall has been accomplished primarily with pectoralis major muscle flaps. Complications have been few, morbidity has been significantly reduced and mortality, thus far, has been eliminated, although we certainly have no expectations that it will remain so.