**10. Conclusion**

DSWI remains a potentially fatal complication of cardiac surgery. Even though risk factors for development of DSWI have been identified, few are modifiable. Tight perioperative glycemic control, proper surgical technique, skeletonization of IMA grafts particularly in diabetics, and primary stable sternal approximation for high risk patients including diabetics, obese, immunosuppressed or those with COPD seem to reduce the risk of DSWI. Thanks to the unique combination of closed and open chest treatment, NPWT positively influences the survival of DSWI patients even at long-term follow-up in comparison with conventional therapy. Transverse titanium plates alone or with auto- or allograft bone allows chest cage stability irrespective to the bone mass loss. Better quality of life and lower extent of soft tissue defect might be promising for these patients who faced sternal instability and considerable flaprelated morbidity some/few years ago. Plastic surgeons should be included in team planning post-DSWI sternotomy wound closure, not only called when previous closure attempt failed or residual defect seems to be extent.

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