The effect of costal cartilage resection on chest wall development

Abstract

The surgical repair of anterior chest malformations such as pectus excavatum and pectus carinatum frequently includes resection of the costal cartilages. Although this operation corrects the external deformity, we have observed that subsequent growth of the chest seems to be restricted, particularly in its anteroposterior (AP) diameter. This study examined the effect of removal of costal cartilage at an early age on chest wall development. Four groups of young rabbits were included: group I underwent complete subperichondrial resection of the costal cartilages excluding the 1st cartilage; group II underwent resection of the internal three-fourths of the costal cartilages; group III underwent complete resection of the costal cartilages with the additional placement of a metallic strut behind the lower half of the body of the sternum; group IV served as a control. Each group included 10 animals. Chest growth was evaluated monthly in all animals. A striking chest growth deficit, mainly in AP diameter, was noticed in those animals that underwent total and partial cartilage resection with or without placement of a metal strut. These results suggest that the costal cartilages play an important role in chest growth. It appears necessary to develop alternative techniques that avoid the removal of costal cartilages and to re-evaluate the optimal age for repair of these malformations.