Diagnosis and management of post-sternotomy wound infections after cardiac surgery: an updated comprehensive review

Post-sternotomy wound infection (PSWI), particularly deep sternal wound infection (DSWI), sternal osteomyelitis, and post-sternotomy mediastinitis, is an uncommon but serious complication of cardiac surgery. Inconsistent terminology, heterogeneous diagnostic thresholds, and marked variation in antimicrobial and reconstructive practice have limited comparison across studies. This updated comprehensive narrative review was based on database-specific searches of PubMed, Web of Science Core Collection, China National Knowledge Infrastructure, and Wanfang Medical for literature published from January 2011 through June 2026, supplemented by reference tracking of major professional guidance documents. Evidence was prioritized by design and clinical relevance and was appraised at source level using a structured hierarchy covering study design, sample size, population, clinical role, principal limitations, and applicability. Case reports, conference abstracts, and small series were retained only when they illustrated rare pathogens, unusual diagnostic problems, or technically complex reconstruction, and they were not used to generate comparative efficacy estimates. A clinically useful review must distinguish superficial incisional infection, deep incisional infection, sternal osteomyelitis, and mediastinitis. Diagnosis requires integration of wound findings, systemic manifestations, deep microbiological sampling, and imaging; no single inflammatory biomarker or molecular assay can be regarded as universally diagnostic. Computed tomography is the principal cross-sectional imaging method, whereas quantitative polymerase chain reaction (qPCR), metagenomic next-generation sequencing (mNGS), and 18F-FDG PET/CT may be useful in selected difficult cases but remain limited by timing, contamination, cost, accessibility, and incomplete standardization. Management of DSWI requires prompt source control, culture-directed antimicrobial treatment, assessment of sternal viability and stability, and early multidisciplinary collaboration. Negative-pressure wound therapy can be used as a bridge to definitive closure, but it is not a substitute for adequate debridement or timely reconstruction. Current evidence supports a structured, multidisciplinary approach rather than a single universally superior diagnostic test, antimicrobial regimen, or reconstructive technique. Most comparative treatment evidence remains retrospective and vulnerable to selection bias; future studies should use standardized definitions, prespecified outcomes, prospective multicenter designs, and health-economic evaluation.