Staphylococcus coagulase negative epidermidis or S. au- reus (including methicillin-resistant S. aureus) account for 50% of surgical site infections. Other organisms that are often involved are Corynebacterium and enteric gram-negative bacilli.966 968 Antibiotic prophylaxis against these organisms should be initiated 30 to 60 minutes before surgery, usually at the time of anesthetic induction, except for vancomycin, which should be started 2 hours before surgery and infused slowly to avoid the release of histamine.903,969,970 In patients without methicillin-resistant S. aureus colonization, a cepha- losporin (cefazolin, 1 g given intravenously every 6 hours, or cefuroxime, 1.5 g given intravenously every 12 hours) is the agent of choice for standard CABG.897 905 Antibiotic redosing is performed if the operation lasts 3 hours.970 Vancomycin is reserved for the patient who is allergic to cephalosporins or has known or presumed methicillin-resistant S. aureus The incidence of deep sternal wound infection has de- creased over the past 15 years despite an increased risk profile of patients undergoing cardiac surgery (ie, increased comor- bidities, obesity, diabetes mellitus, and advanced age).971 Several options are available for the treatment of deep sternal wound infection. The main treatment is surgical debridement with primary or delayed reconstruction with vascularized soft tissue (pectoral muscle or omentum).909 912,972 Conventional treatment with pectoralis flap muscle or omentum is associ- ated with procedure-related morbidities, such as destabiliza- tion of the thoracic cage, surgical trauma, and potential failure of the flap. In current practice, the vacuum-assisted closure system is often used in the treatment of mediastini- tis.913 With it, local negative pressure is applied to the open wound, accelerating granulation tissue formation and increas- ing blood supply. 