Management of Bone Bleeding During Surgery and Its Impact on the Incidence of Post-Operative Osteomyelitis

Abstract

A wide range of orthopedic, cardiothoracic, neurological, and maxillofacial procedures requires that the bone be cut or resected, either to operate on the osseous tissue itself or to gain access to other organs. As any living tissue, bone bleeds when cut or fractured, and to reduce the risk of post-operative complications, bone bleeding needs to be managed during surgery. The present chapter examines the relationship between the management of bleeding and post-operative complications, and, in particular, the impact of bone hemostasis materials on the incidence of post-operative infection of soft tissue and osteomyelitis. Section 2, “Bone Surgery and Management of Bleeding,” opens the argument by discussing the increase in the number of procedures involving the bone, the importance of effective bone and soft tissue hemostasis for assuring positive surgical outcome, and the surgeons’ reliance on bone wax composed of beeswax, despite serious complications associated with its use. Section 3, “Surgical Site Infections and Osteomyelitis,” focuses on the growing incidents of surgical site infections and postoperative osteomyelitis, and the added risk posed by the presence of antibiotic-resistant bacteria. Section 4, “Antibiotic Prophylaxis,” discusses systemic SSI prevention and the use and effectiveness of topical antibiotic prophylaxis. “Systemic and Perioperative Risk Factors for Postoperative Osteomyelitis,” in Section 5 analyses infection risk factors and predictors of complications following cardiac, orthopedic, and neurosurgical procedures. It focuses on excessive bleeding and subsequent extended duration of surgical procedure as infection risk factors, and the importance of effective bone hemostasis in minimizing the risk. Section 6, “Bone Wax as a Modifiable Risk Factor for Osteomyelitis, Chronic Inflammation, and Inhibited Bone Healing,” discusses a body of research linking the use of traditional bone wax, most widely used bone hemostasis material, to inhibition of bone healing, inflammation, and increased soft tissue infection and osteomyelitis rates. The use of bone wax – and the choice of bone hemostasis material in general – remains a largely overlooked modifiable risk factor for osteomyelitis and other post-operative infections. Surgeons are often unaware of the post-operative complications attributed to the use of bone wax and unfamiliar with the range of alternatives available for bone hemostasis. Section 7, “Alternative Bone Hemostasis Materials and Methods,” elaborates on a wide