For more than a century, softened beeswax (also known as bone wax) has been used to achieve bone hemostasis. Because of its ease of application and effectiveness, it still remains among the more common methods used. Numerous complications have been attributed to bone wax. These are typically attributed to the insoluble nature of the material, its inability to be metabolized or resorbed, and its indefinite persistence at the site of application. The published adverse effects of bone wax include inhibition of osteogenesis, infection, foreign body granulomata, local inflammation, and pain [1Wellisz T. Armstrong J.K. Cambridge J. Fisher T.C. Ostene, a new water-soluble bone hemostasis agent.J Craniofac Surg. 2006; 17: 420-425Crossref PubMed Scopus (45) Google Scholar]. A human cadaveric study showed impaired sternal healing manifested by persisting chronic inflammation as long as 10 years after application [2Sudmann B. Bang G. Sudmann E. Histologically verified bone wax (beeswax) granuloma after median sternotomy in 17 of 18 autopsy cases.Pathology. 2006; 38: 138-141Crossref PubMed Scopus (57) Google Scholar]. Alternative bone hemostasis agents, such as oxidized cellulose/polyethylene glycol), fibrin/collagen paste, gelatin paste, patient-derived fibrin sealant, polyorthoester, and hydroxyapatite putty, have not found widespread use. Commercially available agents, including microfibrillar collagen, thrombin, gelatin, and oxidized cellulose, reportedly interfere with various aspects of bone healing [3Magyar C.E. Aghaloo T.L. Atti E. Tetradis S. Ostene, a new alkylene oxide copolymer bone hemostatic material, does not inhibit bone healing.Neurosurgery. 2008; 63: 373-378Crossref PubMed Scopus (32) Google Scholar]. The continued use of bone wax may be due, in fact, to the lack of effective alternative agents that are equally simple to use and achieve immediate and durable bone hemostasis. Ostene (Ceremed Inc., Los Angeles, CA) is a newly available local hemostatic material prepared from water-soluble copolymers. Dr Vestergaard and colleagues [4Vestergaard R.F. Brüel A. Thomsen J.S. Hauge E.M. Søballe K. Hasenkam J.M. The influence of hemostatic agents on bone healing after sternotomy in a porcine model.Ann Thorac Surg. 2015; 99: 1005-1012Scopus (10) Google Scholar] compared the tissue response to Ostene with that of bone wax. Their study showed no evidence of impaired bone healing in the former group, similar to a number of previously published studies from various surgical specialties. Ostene provides the clinician with a water-soluble bone hemostasis material that does not demonstrate the adverse tissue response or the interference with bone healing seen with the use of bone wax and other compounds. The use of this polymer material in place of bone wax may be another step toward reducing wound adverse events and the associated morbidity after cardiac surgery. A human trial is expected to illuminate the material’s true value in successfully limiting some of the healing complications of median sternotomy. The Influence of Hemostatic Agents on Bone Healing After Sternotomy in a Porcine ModelThe Annals of Thoracic SurgeryVol. 99Issue 3PreviewSternotomy is the preferred access to the mediastinum. During sternotomy, trabecular bone is exposed, often resulting in bleeding, which can be treated with mechanical hemostatic agents; however, their influence on the healing process is relatively unexplored. The aim of this study was to investigate the influence of two hemostatic agents: bone wax (BW) and a water-soluble polymer wax, Ostene (WSW), on the mechanical and histologic characteristics of healing sternal bone. Full-Text PDF