Maintenance of chest wall stability: a further report.

The need to maintain stability of the chest wall with stainless steel strips in three unusual sets of circumstances is explained. That 'flail' chest is not synonymous with 'stove-in' chest is made clear. Some of the problems which relate to the maintenance of chest wall stability were discussed in a previous paper (le Roux, 1964). In respect of restoration of rigidity of the chest wall after re-section of rib and sternal tumours, acrylic resin has now been used in 58 patients. Rigidity has been effectively restored in all. In three cases, one illustrated (Fig. 1 a-c), the prosthesis has had to be removed after three months because of persistent infection in relation to it. After removal of the prosthesis in these three patients, the chest wall was stable and a further manoeuvre aimed at maintenance of stability was not necessary. In the previous paper on this subject, mention was made of the use of stainless steel struts to support the sternum after correction of pectus There are commercially available steel struts (Jensen et al., 1962) made of specially annealed cold rolled alloy 302 surgical stainless steel, in lengths which range from 14 to 41 cm, and 12 to 14 mm in breadth. Three unusual sets of circumstances made it necessary to use similar struts', since techniques of maintenance of chest wall stability previously described were thought likely to prove unsatisfactory. The purpose of this paper is to describe the three cases in which stainless steel struts were used to maintain chest wall stability. CASE REPORTS CASE 1 A woman of 28 years had a severe degree of pectus excavatum. In addition there was a deep depression in the left anterior chest wall, immediately below an unusually small left breast. Mobilization of the sternum, resection of deformed costal cartilage, and dicing of deformed left ribs rendered the chest wall unstable, and the manoeuvre aimed at maintenance of stability after correction of pectus exca-'Made at short notice in the workshops at vatum usually employed (a Steinmann's pin laid across the gap created by excision of deformed cartilage, deep to the sternum, and superficial to the lateral ribs) was inappropriate because of the instability of the left lower ribs on which the pin would have needed to rest. A stainless steel strut, suitably curved, was so placed, deep to the stemum and the mobilized left chest wall, and superficial to right-sided ribs and …