Chest Wall Reconstruction Cohort

January 3, 2026 updated by: Zeeshan Sarwar, University of Health Sciences Lahore

Comparative Outcomes of Chest Wall Reconstruction Using Twisted Steel Wires Versus Bone Cement: A Cohort Study

Chest wall reconstruction following tumor or infection-related resections remains a challenging aspect of thoracic surgery, requiring restoration of structural stability and preservation of respiratory mechanics. While polymethyl methacrylate (PMMA) bone cement has long been used for rigid reconstruction, its limitations-including high cost, rigidity, infection risk, and interference with normal respiratory motion-pose challenges in resource-constrained settings. Twisted stainless steel wires offer a low-cost, flexible alternative that allows dynamic chest wall movement and easier adaptability in low- and middle-income countries such as Pakistan.

To compare postoperative outcomes, complications, and cost-effectiveness of chest wall reconstruction using twisted stainless steel wires versus PMMA bone cement over a two-year period (January 2025 - December 2026).

This prospective cohort study was conducted in the Department of Thoracic Surgery, Services Hospital, Lahore, a high-volume tertiary care and referral center. Patients undergoing chest wall reconstruction following resection for tumors, infections, or trauma were enrolled and divided into two groups based on the reconstruction technique used: Group A (twisted steel wires) and Group B (PMMA bone cement). Parameters assessed included postoperative pain (VAS scores), respiratory function, chest wall stability, complications (infection, wound dehiscence, prosthesis exposure), duration of hospital stay, readmission rate, and cost of reconstruction. Data were analyzed to compare clinical and functional outcomes between both cohorts.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Chest wall resection for tumors results in complex structural defects that require meticulous reconstruction to restore stability, protection, and respiratory function. The chest wall, composed of a combination of bony and soft tissue components, plays a crucial role in ventilation; thus, its reconstruction must achieve mechanical integrity while preserving physiologic mobility and minimizing postoperative morbidity.

Multiple techniques and materials have been developed for chest wall reconstruction, including synthetic meshes, titanium plates, and polymethyl methacrylate (PMMA) bone cement. PMMA remains widely used due to its moldability and compressive strength; however, its rigidity, low tensile strength, poor adhesion, and potential for thermal necrosis and infection limit its functional and clinical effectiveness. Furthermore, its high cost and non-dynamic properties make it less suitable in resource-constrained settings.

In contrast, twisted stainless steel wires (No. 05) offer a simple, durable, and cost-effective alternative. These wires provide robust mechanical support with dynamic flexibility, preserving normal respiratory motion and chest wall recoil. Recent advancements have demonstrated that wire-reinforced neorib configurations can achieve both tensile and compressive strength comparable to rigid prosthetics, while avoiding the static limitations of PMMA. Their affordability and availability make them particularly advantageous in low- and middle-income countries where economic feasibility dictates surgical decisions.

Recent studies have further explored biologic and synthetic prosthetic materials, microvascular flaps, and hybrid "biosandwich" techniques to optimize chest wall reconstruction outcomes. Nevertheless, data comparing simple, low-cost methods such as twisted steel wire constructs and PMMA-based reconstructions remain limited, particularly in regions with restricted access to advanced materials. In Pakistan, evidence is largely confined to isolated case reports, including a novel reconstruction of a neosternum using steel wires for recurrent sternal chondrosarcoma.

The present cohort study, conducted in the Department of Thoracic Surgery at Services Hospital, Lahore, aims to compare the outcomes of chest wall reconstruction using twisted stainless steel wires versus PMMA bone cement over two years from January 2025 to December 2026. By evaluating postoperative pain, respiratory function, chest wall recoil, and complication rates, this study seeks to provide evidence-based recommendations for the optimal reconstructive strategy in resource-limited healthcare environments.

Study Type

Interventional

Enrollment (Estimated)

50

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Pakistan
    • Punjab Province
      • Lahore, Punjab Province, Pakistan, 54000
        • Recruiting
        • Services Hospital, Lahore
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Patients aged ≥18 years undergoing partial or full-thickness chest wall resection.
  • Defects requiring rigid or semi-rigid reconstruction involving two or more ribs or the sternum.

Exclusion Criteria:

  • Patients with small defects managed by primary closure or soft tissue-only reconstruction.
  • Patients with concurrent major intrathoracic resections (e.g., pneumonectomy) may confound postoperative respiratory assessment.
  • Recurrent disease requiring revision reconstruction.
  • Patients unwilling or unable to provide consent or comply with follow-up.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Bone cement Arm
This arm included patients that underwent chest wall reconstruction using bone cement
Procedure: chest wall reconstruction
Chest wall reconstruction was performed using PMMA bone cement molded intraoperatively over a polypropylene mesh to form a rigid prosthesis. The construct was fixed to the adjacent ribs with nonabsorbable sutures or wires.
Experimental: Steel wire arm
This arm included patients that underwent chest wall reconstruction with steel wires
Procedure: Chest wall reconstruction
chest wall reconstruction was achieved using twisted stainless steel wires (No. 05) anchored to the adjacent ribs or sternum, creating a flexible rib framework. The wires were tightened in a crisscross fashion to provide stable yet dynamic support.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Postoperative Pain Assessment:
Time Frame: 24 hours, 48 hours and 7 days post-operatively
Postoperative analgesia followed a standardized multimodal protocol of intravenous paracetamol and NSAIDs unless contraindicated, supplemented with intravenous morphine (0.05-0.1 mg/kg) as required. Thoracic epidural or paravertebral blockade was used selectively based on resection extent or anesthetist preference. Rescue analgesia was administered when VAS pain scores were ≥4 at rest or ≥5 during movement.
24 hours, 48 hours and 7 days post-operatively

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Chest Wall Movement
Time Frame: 1 month and 3 months post-operatively
Chest wall function was evaluated clinically at discharge, at 1-month follow-up, and at 3-month follow-up by the operating surgeon or thoracic fellow, and patients who underwent surgery earlier in the study period remain under active surveillance, providing a total follow-up duration of up to two years. Assessment included inspection for paradoxical movement during quiet and deep breathing and measurement of axillary excursion when feasible. Normal chest movement was defined as symmetrical expansion or ≥3 cm axillary excursion. Restricted movement was defined as <3 cm excursion, ≥25% asymmetry relative to the contralateral side, or patient-reported limitation.
1 month and 3 months post-operatively

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Health Sciences Lahore

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2021

Primary Completion (Estimated)

December 31, 2026

Study Completion (Estimated)

March 31, 2027

Study Registration Dates

First Submitted

January 3, 2026

First Submitted That Met QC Criteria

January 3, 2026

First Posted (Actual)

January 13, 2026

Study Record Updates

Last Update Posted (Actual)

January 13, 2026

Last Update Submitted That Met QC Criteria

January 3, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IRB/2025/1719/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

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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