title: Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review.
abstract: Early recognition and, where possible, avoidance of risk factors that contribute to the development of poststernotomy mediastinitis (PSM) form the basis for successful prevention. Once the presence of PSM is diagnosed, the known risk factors have been shown to have limited influence on management decisions. Evidence-based knowledge on treatment decisions, which include the extent and type of surgical intervention (other than debridement), timing and others is available but has not yet been incorporated into a classification on management decisions regarding PSM. Ours is a first attempt at developing a classification system for management of PSM, taking the various evidence-based reconstructive options into consideration. The classification is simple to introduce (there are four Types) and relies on the careful establishment of two variables (sternal stability and sternal bone viability and stock) prior to deciding on the best available reconstructive option. It should allow better insight into why treatment decisions fail or have to be altered and will allow better comparison of treatment outcomes between various institutions.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands. j.j.vanwingerden@amc.uva.nl.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: van Wingerden
authors.affiliation: Department of Quality Assurance and Process Innovation, Academic Medical Center, Amsterdam, the Netherlands. d.ubbink@amc.nl.
authors.forename: Dirk T
authors.initials: DT
authors.lastname: Ubbink
authors.affiliation: Department of Plastic and Reconstructive Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands. c.m.vanderhorst@amc.uva.nl.
authors.forename: Chantal M A M
authors.initials: CM
authors.lastname: van der Horst
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. b.a.demol@amc.uva.nl.
authors.forename: Bas A J M
authors.initials: BA
authors.lastname: de Mol
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003646:Debridement; D020000:Decision Support Systems, Clinical; D019317:Evidence-Based Medicine; D006801:Humans; D008480:Mediastinitis / Q000209:etiology* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology*; D014945:Wound Healing