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

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

Type	Sternal stability	Bone viability & stock	Reconstruction	Staging of reconstruction
1	Stable	Reasonable	TNP	(class I, level B)
2a			Local muscle flap*	Primary
2a			Local muscle flap*	(class II, level B)
2b			Muscle** or Omentum flap	Delayed
2b			Muscle** or Omentum flap	(class I, level B).
3a	Unstable	Viable & sufficient	Rewiring/osteosynthesis	Primary^#
				Delayed^
				(class IIb, level B)
3b			Rewiring/osteosynthesis	Primary^#
			Rewiring/osteosynthesis	Delayed^
			and
			Muscle** or Omentum flap
			Muscle** or Omentum flap	(class IIb, level B)
4a		Necrotic & insufficient	Muscle flap	Primary/ Delayed
4b			Omentum flap	Primary/ Delayed
4b			Omentum flap	(class IIb, level B)
4c			Muscle and Omentum flap	(class IIb, level B)

*Always, unilateral or bilateral pectoralis muscle advancement.
**Frequently, unilateral or bilateral pectoralis muscle advancement.
^#Rewiring.
^Osteosynthesis (plates, clips, etc.).
Important: When definite reconstruction is “delayed”, time interval and temporizing procedure (e.g. TNP) should be specified.

ISSN: 1749-8090