Mediastinitis continues to be a devastating complication of open heart surgery. Supercharging the rectus abdominis muscle through revascularisation of the deep inferior epigastric vessels in the neck adds another safety factor in the management of these difficult problems. Large mediastinal wound defects that would usually require more than one muscle for cover can be covered adequately with this technique. Viability of the entire rectus abdominis is assured and permits use in its entirety. Details of the technique are presented as well as a review of the reconstructive options for mediastinal wound infections. © 1991 The Trustees of British Association of Plastic Surgeons. All rights reserved.