Chest Wall TumorNCT07338006
Chest Wall Reconstruction Cohort
A study testing chest wall reconstruction in people with Chest Wall Tumor and Reconstructive Surgical Procedure, run by University of Health Sciences Lahore at 1 site in Pakistan.
Trial summary
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. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Chest Wall Tumor, Reconstructive Surgical Procedure, Malignancy
- What is being tested?
- chest wall reconstruction
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 50 participants
- Where
- 1 sitePakistan
- Study dates
- 1 Jan 2021to 31 Mar 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- 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.
Who cannot join
- 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.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site, 1 recruiting
- Recruiting
Services Hospital, Lahore
Lahore, Punjab Province, 54000
Muhammad Shoaib Nabi, FCPS, +92 321 4347410, zeeshan.sarwar195@gmail.com
About this study
Official title: 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.
Read the 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.
- Being tested
- chest wall reconstruction
- Keywords
- Chest wall reconstruction, Bone cement, Stainless steel wire, Thoracic surgery, Postoperative pain, Functional outcomes
- Medical subject headings
- Neoplasms, Pain, Postoperative
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
chest wall reconstructionProcedure or surgery
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.
Chest wall reconstructionProcedure or surgery
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.
| Study group | Role | What they receive |
|---|---|---|
| Bone cement Arm | Active comparator | This arm included patients that underwent chest wall reconstruction using bone cement Receives: Procedure: chest wall reconstruction |
| Steel wire arm | Experimental | This arm included patients that underwent chest wall reconstruction with steel wires Receives: Procedure: Chest wall reconstruction |
What is being measured
The primary outcome is the main question the study is designed to answer.
Postoperative Pain Assessment:
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.
Measured: 24 hours, 48 hours and 7 days post-operatively
Secondary outcomes (1)
Chest Wall Movement
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.
Measured: 1 month and 3 months post-operatively
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Jan 2026
- Study start1 Jan 2021
- Primary completion31 Dec 2026 (estimated)
- Study completion31 Mar 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Chest Wall TumorStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 50 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of Health Sciences Lahore
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Zeeshan Sarwar, University of Health Sciences Lahore
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07338006
- Sponsor's protocol ID
- IRB/2025/1719/SIMS
- Status last verified
- Jan 2026
- First submitted
- 3 Jan 2026
- Last updated
- 13 Jan 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 13 Jan 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparative Outcomes of Chest Wall Reconstruction Using Twisted Steel Wires Versus Bone Cement: A Cohort Study
- ClinicalTrials.gov ID
- NCT07338006
- Acronym / sponsor ID
- IRB/2025/1719/SIMS
- Keywords
- Chest wall reconstruction, Bone cement, Stainless steel wire, Thoracic surgery, Postoperative pain, Functional outcomes
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 50 participants (estimated)
- Lead sponsor
- University of Health Sciences LahoreUniversity, hospital or other
- Study start
- 1 Jan 2021 (actual)
- Primary completion
- 31 Dec 2026 (estimated)
- Study completion
- 31 Mar 2027 (estimated)
- First posted
- 13 Jan 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
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 design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Bone cement Arm | Active comparator | Procedure: chest wall reconstructionThis arm included patients that underwent chest wall reconstruction using bone cement |
| Steel wire arm | Experimental | Procedure: Chest wall reconstructionThis arm included patients that underwent chest wall reconstruction with steel wires |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (2 listed)
- 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.
Key exclusion criteria (4 listed)
- 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.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| chest wall reconstructionChest 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. | Procedure or surgery | Bone cement Arm |
| Chest wall reconstructionchest 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. | Procedure or surgery | Steel wire arm |
Primary outcome
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.
1 secondary outcome
Chest Wall Movement
Time frame: 1 month and 3 months post-operatively
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 13 Jan 2026.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing chest wall reconstruction in people with Chest Wall Tumor and Reconstructive Surgical Procedure, run by University of Health Sciences Lahore at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 13 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Muhammad Shoaib Nabi, FCPS (+92 3214347410, zeeshan.sarwar195@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Postoperative Pain Assessment: (time frame: 24 hours, 48 hours and 7 days post-operatively). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Jan 2026.