AMSTERDAM classification

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

AMSTERDAM: Assiduous Mediastinal Sternal Debridement and Aimed Management; TNP: topical negative pressure.
*Important: When definite reconstruction is "delayed", time interval and temporizing procedure (eg, TNP) should be specified.
¶ Always, unilateral or bilateral pectoralis muscle advancement.
Δ Frequently, unilateral or bilateral pectoralis muscle advancement.
◊ Rewiring.
§ Osteosynthesis (plates, clips, etc).

From: van Wingerden JJ, Ubbink DT, van der Horst CM, de Mol BA. Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review. J Cardiothorac Surg 2014; 9:179. Copyright © 2014 van Wingerden et al. Reproduced under the terms of the Creative Commons Attribution License.

Graphic 108796 Version 1.0

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AMSTERDAM classification