Institutional Experience With Chest Wall Reconstruction Using Sternal Steel Wires: A Case Series Study

Chest wall resections, often performed for tumors, infections, or trauma, result in significant defects that require reconstruction to restore structural integrity and functionality. The use of twisted stainless steel wires (No. 05) for chest wall reconstruction offers a cost-effective and practical alternative. Steel wires provide robust structural support, allow dynamic movement of the chest wall during respiration, and are associated with improved postoperative pain control.

Study Overview

• Status: Completed
• Conditions: Chest Wall Disease; Chest Wall Tumor; Chest Wall Mechanics; Chest Wall Deformity
• Intervention / Treatment: Procedure: Chest Wall Reconstruction

Detailed Description

The chest wall, a complex dynamic structure composed of both rigid and soft tissues, plays a vital role in protecting thoracic organs and maintaining the mechanics of respiration. Reconstruction following chest wall resection is critical not only to achieve defect closure but also to preserve respiratory mechanics and minimize postoperative complications. The primary goals include providing structural support, ensuring stability, and achieving soft tissue coverage while maintaining chest wall flexibility and minimizing pain. Chest wall reconstruction using sternal steel wires enable better chest wall recoil, which is crucial for maintaining normal respiratory mechanics. Additionally, studies suggest that the use of steel wires reduces the incidence of chronic pain, as they do not involve direct exposure to synthetic materials that could irritate surrounding tissues or provoke inflammatory responses. The affordability and simplicity of steel wire-based reconstruction make it particularly suitable for underserved populations in Pakistan, where healthcare resources are limited, and the majority of patients cannot afford expensive surgical materials.

• Study Type: Observational
• Enrollment (Actual): 38

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan
      • Services Institute of Medical Sciences (SIMS), Services Hospital, Lahore

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

All participants diagnosed with conditions requiring chest wall reconstruction and admitted to the thoracic surgery ward, emergency department, or outpatient department during the study period will be included in this study.

Description

Inclusion Criteria:

• Patients undergoing chest wall resection due to tumors or trauma.

Exclusion Criteria:

• Patients with contraindications to General Anesthesia.
• Patients having chest wall infection.
• Patients with pre-existing chest wall deformities or severe chronic respiratory diseases.
• Patients who undergo reoperation or develop intraoperative complications affecting the chest wall reconstruction.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Wires Group; all the participants who undergo chest wall reconstruction using sternal steel wires, number 05 are included in this group.	Procedure: Chest Wall Reconstruction; there are many methods described in literature for reconstruction of chest wall after chest wall resection. The investigators are focusing on chest wall reconstruction using steel wires in this study.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Chest Wall Recoil	Chest wall recoil after reconstruction is defined as maintenance of normal chest wall movement during respiration without paradoxical motion. It is assessed using spirometry (Forced Vital Capacity [FVC] and Forced Expiratory Volume in 1 second [FEV1]) compared with baseline/preoperative predicted values, radiological evaluation (postoperative chest X-rays for symmetrical expansion) and clinical observation (absence of paradoxical chest wall movement on examination). Preserving chest wall recoil is essential for normal breathing mechanics. Reconstruction with sternal steel wires aims to restore physiological elasticity, maintain ventilatory efficiency, and reduce respiratory complications.	30 days post-operatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post-Operative Pain Control	Post-operative pain control is measured using the Visual Analogue Scale (VAS) ranging from 0 (no pain) to 10 (worst imaginable pain). It is recorded at 24 hours, 72 hours, and 7 days postoperatively. Pain is a critical determinant of recovery, respiratory function, and overall patient satisfaction. Evaluating pain scores will help determine whether sternal steel wire fixation provides a less painful and more tolerable method of chest wall reconstruction compared to alternative techniques.	24 hours, 72 hours and 07 days

Collaborators and Investigators

• Sponsor: University of Health Sciences Lahore
• Investigators: Principal Investigator: Muhammad Shoaib Nabi, Professor Of Thoracic Surgery, Services Institute of Medical Sciences (SIMS), Services Hospital, Lahore

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2023
• Primary Completion (Actual): April 30, 2025
• Study Completion (Actual): July 31, 2025

Study Registration Dates

• First Submitted: August 23, 2025
• First Submitted That Met QC Criteria: August 23, 2025
• First Posted (Estimated): August 29, 2025

Study Record Updates

• Last Update Posted (Estimated): August 29, 2025
• Last Update Submitted That Met QC Criteria: August 23, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Keywords: respiratory mechanics; sternal steel wires; chest wall reconstruction; flail segment; chest wall tumors; chest wall resection
• Other Study ID Numbers: IRB/2025/1653/SIMS

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No