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Table 2 AMSTERDAM classification (Assiduous Mediastinal Sternal Debridement & Aimed Management)

From: Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review

Type Sternal stability Bone viability & stock Reconstruction Staging of reconstruction
1 Stable Reasonable TNP (class I, level B)
2a Local muscle flap* Primary
(class II, level B)
2b Muscle** or Omentum flap Delayed
(class I, level B).
3a Unstable Viable & sufficient Rewiring/osteosynthesis Primary#
Delayed^
(class IIb, level B)
3b Rewiring/osteosynthesis Primary#
Delayed^
and
Muscle** or Omentum flap
(class IIb, level B)
4a Necrotic & insufficient Muscle flap Primary/ Delayed
4b Omentum flap
(class IIb, level B)
4c Muscle and Omentum flap
  1. *Always, unilateral or bilateral pectoralis muscle advancement.
  2. **Frequently, unilateral or bilateral pectoralis muscle advancement.
  3. #Rewiring.
  4. ^Osteosynthesis (plates, clips, etc.).
  5. Important: When definite reconstruction is “delayed”, time interval and temporizing procedure (e.g. TNP) should be specified.