Balloon expansion of the pectoralis major muscle flap in sternoplasty: A biomechanical and histologic study in a rat model

The pectoralis major advancement flap is currently the most popular technique for reconstruction of the anterior chest in patients with sternotomy wounds. Recently, the SpaceMaker balloon was introduced for rapid expansion of the pectoralis major muscle intraoperatively. The aim of the present study was to investigate the biomechanical and histologic effects of this expansion technique in a rat model. The upper 2 cm of the sternum was resected in 54 male rats. Reconstruction with balloon-assisted pectoralis muscle expansion was performed in 24 rats (study group). Another 24 rats underwent reconstruction with simple muscle advancement without expansion. Submuscular insertion of a catheter for expansion, without inflation, was performed in the remaining six rats (sham group). Rats were killed either immediately or 2 to 4 weeks after surgery. Thirty-eight rats, including 16 after reconstruction with expansion, 16 after reconstruction without expansion, and six in the sham group, were killed immediately after surgery. Sixteen rats were killed 2 to 4 weeks after surgery, eight rats for each reconstruction technique. Before the animals were killed, the biomechanical properties of the muscles were tested with weights to calculate stiffness (in newtons per meter) and compliance gain (in percent). After the animals were killed, biopsy specimens were obtained for histologic analysis. Results indicated significantly lower muscle stiffness in the study group compared with the others immediately after surgery (p = 0.0000), although the difference failed to achieve statistical significance 2 to 4 weeks later (p = 0.76). In the study group, the compliance gain was 74.4 percent immediately after surgery but only 3.4 percent 2 weeks to 1 month postoperatively. Histologic examinations in all groups immediately and 2 to 4 weeks after surgery revealed regular muscle striation with no signs of inflammation. The elastic stiffness of the rat pectoralis major muscle is significantly reduced following rapid intraoperative expansion and returns to normal 2 to 4 weeks later.