Background and objective: The midline sternotomy advocated by Julian 1957 allowed the surgeon excellent access to mediastinal structures. Disruption and infection of median sternotomy wounds are grave complications, occurring in 0.3-5% as an average of many literature. The problem is associated with a mortality rate between 14-47%, usually secondary to underlying mediastinitis, a complex condition with widely variable features. Early treatment protocols used open packing of the debrided wound and required months to achieve a healed wound. Subsequent treatment focused on debridement with antibiotic irrigation. Then pectoralis muscle flap and omental flap introduced a new success in mediastinitis treatment. Methodology: Sixty patients with mediastinitis requiring surgical intervention were divided into two groups. Group (A) patients were subjected to debridement of all infected tissues and rewiring over mediastinal drainage. Group B patients were subjected to one of the reconstructive procedures to correct chest wall defect and mediastinitis as muscle flap or omental flap. Results: There was no statistically significant difference between both groups before doing open heart surgery. After infection group A patients had more culture negative results for their wounds which was statistically significant. Post reconstruction procedure group B patients lost more blood in their drainage than group A patients. Both groups had ICU and hospital stay which was statistically insignificant in difference. Conclusion: Early diagnosis and proper management of mediastinitis will help in good results. Debridement of all infected tissues is the key point. Rewiring if possible (good sternal bulk remaining) or muscle flap or omental flap will give good results.