Costal chondritis: the costal arch.

Infections of the costal cartilages lead to serious sequelae. This report deals with the diagnosis of such infections, proposed treatment, and an illustrative case history from our experience. Previous therapeutic regimens advocated excision of the entire costal cartilage if any portion was infected. In cases where the infection is confined to cartilages not involving the costal arch, this is an effective therapy. However, in infections of the costal arch, complete removal leads to gross deformity, loss of skeletal protection of the heart and liver, and chest wall instability with serious respiratory failure. Segmental cartilaginous resection followed by a period of healing and subsequent debridement of only the infected and necrotic cartilage is the preferred method for treatment of infection involving the costal arch.