Vacuum-assisted sternal closure after a 'depression induced ischemic test' in severe mediastinitis

We present a case of a 71-year-old patient with arterial myocardial revascularization and postoperative course complicated with sternal wound diastasis and subsequent mediastinitis. The patient underwent double revision of the mediastinum: the first in 13th and the second in 27th with total sternectomy. Although the resulting external exposure of pericardial cavity and grafts is a contraindication for using vacuum-assisted closure (VAC), we used it after a 'depression induced ischemic test' (DIIT) to evaluate ischemic threshold. After the VAC therapy period (from 32nd to 112th postoperative day), the sternal wound was ready to close. We think that VAC-therapy is a safe and economic approach in the treatment of serious substance loss even with pericardial cavity and graft exposure.