IntroductionSince Shoemaker first performed midline sternotomy in an elective cardiac operation in 1953, midline sternotomy has become the most common approach for most cardiac surgical operations, as this is easy to perform, causes less pain, and provides good exposure. However, complications of this approach, such as deep sternal wound infection, fragmented sternum, paramedian sternotomy (1), and non-union lead to significant risks of morbidity and mortality. Surgeons use various methods and techniques to deal with these complications (2), including: closed suction antibiotic catheter irrigation systems (3) , vacuum-assisted closure (4), omental transposition (5), unilateral or bilateral pectoralis major muscle turnover flap in mediastinitis (6), pectoralis major muscle transposition for infected sternotomy wounds (7), pedicle pectoralis major muscle rotation advancement flap (8, 9, 10), bilateral myocutaneous pectoralis major muscle flaps (11), rectus abdominus muscle flap (12), pectoralis major-rectus abdominis bi-pedicle muscle flap (13), latissimus dorsi muscle flap (14), microsurgical free flap (15), primary sternal closure with titanium plate fixation (16), one-step radical sternal debridement and muscle flap(s) reconstruction (17), and various combinations of the above. Bilateral myocutaneous pectoralis major muscle flaps have been used as a single-stage management of deep sternal wound infections without re-approximation of sternal edges or with osteo-synthesis (18, 19, 20).The authors have used bilateral pectoralis major myocutaneous flaps based on the thoraco-acromial pedicle to manage sternal wound dehiscence in 42 patients from 2003 – 2019. These patients were originally operated on by various cardiac surgeons. This procedure can easily be done by a cardiac surgeon without the involvement of the plastic surgeons. The authors detach the left and right pectoralis muscles from their sternal origin as well as free the deep surface of pectoral muscle from the chest wall attachments. This technique eliminates the oppositely directed dragging forces on two halves of the sternum by right and left pectoralis muscle contraction. Hence, this technique removes all kinds of pull on two halves of the sternum. This will allow the two halves of the bone to remain in contact and ultimately heal. Pectoralis muscles of both sides suture together, therefore when they contract, they pull each other, rather than pull the bone. The upper limbs movements remain u...