title: Successful surgical treatment of traumatic sternal fracture with extensive mediastinal abscess and concomitant mitral valve endocarditis: a case report.
abstract: BACKGROUND
  A traumatic sternal fracture with extensive mediastinal abscess and concomitant native valve endocarditis is an extremely rare but catastrophic situation.
  
  
  METHODS
  For 2 weeks, the co-infected patient was treated with aggressive debridement for the mediastinitis, change of vacuum-assisted closure therapy dressings, vegetectomy and valve repair through lower partial sternotomy, and delayed primary wound closure.
  
  
  CONCLUSIONS
  To the best of our knowledge, this successful staged strategy has not been previously reported. We believe that our quick decision about repeated surgical interventions and preservation of the manubrium led to a favorable result.
authors.affiliation: Department of Cardiovascular Surgery, Okinawa Prefectural Nambu Medical Center and Children's Medical Center, Haebaru, Japan. h-munakata@k7.dion.ne.jp.
authors.forename: Hiroshi
authors.identifier: http://orcid.org/0000-0002-8016-4069
authors.initials: H
authors.lastname: Munakata
authors.affiliation: Department of Cardiovascular Surgery, Okinawa Prefectural Nambu Medical Center and Children's Medical Center, Haebaru, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Murakami
authors.affiliation: Department of Cardiovascular Surgery, Okinawa Prefectural Nambu Medical Center and Children's Medical Center, Haebaru, Japan.
authors.forename: Katsuhito
authors.initials: K
authors.lastname: Mabuni
authors.affiliation: Department of Emergency and Critical Care Medicine, Okinawa Prefectural Nambu Medical Center and Children's Medical Center, Haebaru, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuchiya
authors.affiliation: Department of Emergency and Critical Care Medicine, Okinawa Prefectural Nambu Medical Center and Children's Medical Center, Haebaru, Japan.
authors.forename: Moriaki
authors.initials: M
authors.lastname: Shinzato
authors.affiliation: Department of Emergency and Critical Care Medicine, Okinawa Prefectural Nambu Medical Center and Children's Medical Center, Haebaru, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Umemura
authors.affiliation: Department of Cardiovascular Surgery, Okinawa Prefectural Nambu Medical Center and Children's Medical Center, Haebaru, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Kugai
mesh_terms: D000038:Abscess / Q000150:complications / Q000601:surgery*; D000369:Aged, 80 and over; D004696:Endocarditis / Q000150:complications / Q000601:surgery; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery*; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000150:complications / Q000601:surgery*; D008943:Mitral Valve / Q000601:surgery*; D013249:Sternum / Q000293:injuries* / Q000601:surgery
keywords: Aggressive debridement; Endocarditis; Mediastinitis; Successfully staged strategy; Traumatic sternal fracture