Use Of Bone Wax Research Articles

Efficacy and Safety of Bone Wax Application at Different Time Points to Reduce Postoperative Blood Loss in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial.

In addition to the surface hemorrhage of cancellous bone after large-area osteotomy, the intramedullary hemorrhage after the reamed knee joint is also a major cause of postoperative bleeding after total knee arthroplasty (TKA). This study evaluated the efficacy and safety of bone wax application at different time points of prone hemorrhage to reduce perioperative blood loss. From August 2023 to December 2023, 150 patients undergoing primary unilateral TKA were included in this prospective, randomized controlled trial, patients were randomly divided into three groups: group A, after autogenous osteotomy plug was used to fill the femoral medullary cavity, the residual space was sealed with bone wax and the exposed cancellous bone surface around the prosthesis was coated with bone wax after the prosthesis adhesion; group B, only the exposed cancellous bone surface around the prosthesis was coated with bone wax; and group C, no bone wax was used. The primary outcome was total perioperative blood loss. Secondary outcomes included occult blood loss, postoperative hemoglobin reduction, blood transfusion rate, lower limb diameter, and knee function, while length of hospital stay was recorded. Tertiary outcomes included the incidence of postoperative related adverse events. The total blood loss in group A (551.5 ± 224.5 mL) and group B (656.3 ± 267.7 mL) was significantly lower than that in group C (755.3 ± 248.3 ml, p < 0.001), and the total blood loss in group A was also lower than that in group B (p < 0.05). There were also significant differences in the reduction of hemoglobin level and hidden blood loss among the three groups (p < 0.05). However, there was no significant improvement in postoperative lower limb swelling, knee joint activity and hospitalization time; there was no significant difference in the incidence of complications such as thromboembolism. The use of bone wax in TKA can safely and effectively reduce perioperative blood loss and hemoglobin drop rate, and multiple use at time points during the operation when blood loss is prone to occur can produce more significant hemostatic effect.

The Use of Bone Wax in Hemostatic Control for Total Knee and Hip Arthroplasties: A Systematic Review.

Background/Objectives: Blood loss can be a serious complication in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Various methods are used by surgeons to achieve hemostatic control in these patients. Complications are associated with perioperative blood loss. In this systematic review, we examined the efficacy of using bone wax to control bleeding in patients undergoing THA and TKA. Methods: The PRISMA model was used to systematically identify and aggregate articles for this study. The PubMed and EMBASE databases were used to search individual studies that examined the use of bone wax in THA or TKA. After applying the search term "bone wax", 2478 articles were initially identified. After inclusion and exclusion criteria were applied, three articles were aggregated for this systematic review. Results: The use of bone wax in THA and TKA decreased blood loss in patients undergoing these operations. Postoperative blood loss following surgery was lower in the bone wax groups compared to the control groups as well. Patients in the bone wax groups also required fewer blood transfusions than those who did not receive bone wax. Conclusions: Bone wax appears to be another modality that can be used by physicians to maintain hemostatic control in THA or TKA patients. Reduced blood loss and transfusion rates in surgery can increase patient outcomes. More studies are needed to examine the efficacy of bone wax in comparison with other hemostatic tools.

The use of bone wax versus dermal regeneration matrix for the reconstruction of scalp defects.

Secondary intention healing is an alternative to consider in large tumors or tumors located in areas of limited skin mobility, such as the scalp. To promote epithelialization, we can use Dermal Regeneration Matrix (DRM) or bone wax. This study aimed to compare the efficacy of DRM and bone wax in secondary intention healing of cutaneous scalp tumors in elderly patients with comorbidities. The medical records of 18 patients with cutaneous scalp tumor healing by secondary intention from February 2022 to April 2023 were analyzed for demographic variables, tumor and surgical characteristics, time from withdrawal of material to complete epithelialization, and need for subsequent surgical intervention. Bone wax was used in 6 patients and DRM in 12. The mean patient age was 84.3 years, and the mean tumor size was 2.7 cm. There were no significant differences in demographics or postoperative complications between the groups. The median time to complete epithelization was 84.5 (60.2-108.7) days in the bone wax group and 105.0 (91.0-126.0) days in the DRM group, with no significant differences (P = 0.15). Bone wax is a simple and economical material that can be used for secondary intention healing of scalp tumors in elderly patients with high surgical risk.

Use of bone wax as a nail bed dressing after excision of subungual tumors

Use of bone wax as a nail bed dressing after excision of subungual tumors

Development of novel waxy bone hemostatic agents composed of biodegradable polymers with osteogenic-enhancing peptides in rabbit models.

The use of bone wax is controversial for sternal hemostasis because it increases the risk of wound infection and inhibits bone healing. We developed new waxy bone hemostatic agents made from biodegradable polymers containing peptides, and evaluated them using rabbit models. We designed two types of waxy bone hemostatic agents: peptide wax and non-peptide wax, which used poly(ε-caprolactone)-based biodegradable polymers with or without an osteogenesis-enhancing peptide, respectively. Rabbits were randomly divided into four groups based on treatment with bone wax, non-peptide wax, peptide wax, or no treatment. In a tibial defect model, the bleeding amount was measured and bone healing was evaluated by micro computed tomography over 16 weeks. Bone healing in a median sternotomy model was assessed for 2 weeks using X-ray, micro computed tomography, histological examination, and flexural strength testing. The textures of peptide and non-peptide wax (n = 12 each) were similar to that of bone wax, and achieved a comparable degree of hemostasis. The crevice area of the sternal fracture line in the bone wax group was significantly larger than that in other groups (n = 10 each). The peptide wax group demonstrated the strongest sternal flexural strength (n = 10), with complete tibial healing at 16 weeks. No groups exhibited wound infection, including osteomyelitis. Waxy biodegradable hemostatic agents showed satisfactory results in hemostasis and bone healing in rabbit models, and may be an effective alternative to bone wax.

Bone Wax as a Physical Hemostatic Agent

Achieving hemostasis in cutaneous surgery on bony or irregular surfaces can be challenging; typical pressure dressings that act by mechanical occlusion with petrolatum gauze can be inadequate. We offer the use of bone wax as a practical hemostatic agent that can be (1) molded to provide ideal occlusion and pressure without adhering to wound surfaces and (2) painlessly and simply removed.

Bone wax causing a middle trunk plexopathy following vertebral artery injury: a neuroradiological pitfall

BackgroundBone wax is a hemostatic agent widely used in surgery. Since it is neither absorbed nor metabolized, its use remains risky and a potential cause of complications. Even though its MRI radiological characteristics are distinguishable, it is generally misinterpreted as postoperative hematoma or trapped air. We report the first case in literature of brachial plexopathy due to the compressive mass effect of bone wax and the main clues that led us to establish this diagnosis prior to its surgical resection.Case presentationA 20-year-old male, victim of stabbing presented with an open wound of the right latero-cervical region with a vascular injury of the V2 segment of the right vertebral artery on CT angiography. He was first admitted for bleeding from the neck uncontrollable with external pressure. The patient underwent an emergency surgical vertebral artery ligation. Forty-eight hours later, he reported a feeling of paresthesia of right arm with right-sided weakness. Neurologic examination revealed a motor deficit of the right triceps and wrist extensor muscles and absence of the triceps reflex. A postoperative compression of the C7 cervical root or the middle trunk of brachial plexus was initially suspected. A cervical MRI demonstrated a T1- and T2-weighted images well-defined right mass located laterally to the spinal cord in the epidural space at the level of C6–C7 vertebrae with a signal-intensity void on both sequences. T2*-weighted images showed no signal attenuation. It did not enhance after contrast administration. An epidural hematoma was less probable since acute hematoma is typically hypointense on T2*-weighted images. Computed tomography helped rule out residual postoperative air trapped in the epidural space based on the density study of the mass compared to air. Finally, a residual surgical foreign material used for packing during the procedure was suspected. The massive use of bone wax was ultimately confirmed by the surgeon and surgically removed with complete immediate postoperative recovery.ConclusionsThis case highlights the importance of a nuanced critical approach of neurosurgeons and neuroradiologists when interpreting postoperative neuroimaging scans of the spine. It is crucial to always consider foreign body-related complications and to review the per-operative procedure in details.

Does bone wax make sense in off-pump coronary surgery? A prospective randomized study.

The effect of bone wax on sternal infection and intraoperative bleeding in off-pump coronary surgery has not been reported in current literature. To prospectively evalute this in a cohort of high risk patients undergoing off-pump coronary artery surgery at our institution. The potential impact on cell saver utilization was also studied. A prospective randomized study was performed in 58 diabetic patients operated on for two-vessel coronary artery disease by the off-pump technique. They were randomly assigned to the wax or no-wax group. There was no significant difference in intraoperative blood loss between the wax (550 ml) and no-wax group (750 ml; p = 0.0711). In multivariate analysis the absence (non-use) of bone wax (odds ratio = 3.9 (1.12-13.51), p = 0.027) and preoperative creatinin level (odds ratio = 1.1 (0.99-1.03), p = 0.03) were identified as independent predictors of blood loss ≥ 750 ml. The number of red blood cell units during hospital stay was similar in both groups (p = 0.42). Wound healing complications were not observed in either group. The use of bone wax does not lead to a higher risk of sternal wound infection. It may reduce the risk of high intraoperative blood loss, thus avoiding the need of a cell saver during off-pump coronary surgery. However, this influence remains questionable.

A Comparative Study of Pedicled Versus Skeletonized Left Internal Mammary Artery Harvesting Techniques Regarding Rate of Mediastinitis Post CABG in Diabetic Patients

Background: For grafting the left anterior descending (LAD) coronary artery, the left internal mammary artery (LIMA) has become the gold standard. Pedicled and skeletonized methods are the two most common harvesting procedures. Objective: In this study we compared between both techniques regarding incidence of postoperative mediastinitis in diabetic patients. Patients and methods: 80 diabetic patients with controlled diabetes i.e. HbA1c below 7 underwent on-pump coronary artery bypass grafting (CABG) surgery were included in this study. The patients were divided into two groups, according to the procedure applied to harvest the LIMA: Group 1: 40 patients underwent pedicled LIMA and Group 2: 40 patients underwent skeletonized LIMA. After CABG surgery, the cases had a 3-month follow-up time. Results: In the pedicled LIMA group, the frequency of excessive intraoperative usage of bone wax was significantly increased. A significant increase was found regarding the occurrence of sternal wound infections (SWI) in the pedicled LIMA group (22.5%) versus (12.5%) within the skeletonized one, (P-value = 0.003). The univariate analysis of the factors related to SWI in all of the studied CABG patients were obesity [OR (95% CI): 15.61 (5.78-42.12), P <0.001], pedicled ITA [OR (95% CI): 4.3(1.4-12.9), P 0.004], intraoperative excessive use of bone wax [OR (95% CI): 14.53(6.48-32.56), P <0.001], and intraoperative excessive use of diathermy [OR (95% CI): 17.31(7.55-39.4), P <0.001]. Conclusion: In comparison to pedicled LIMA, skeletonized LIMA in CABG was correlated to reduced occurrence of superficial as well as deep SWI among diabetic patients.

Unusual complications of bone wax at the skull base.

This study aimed to describe the clinical presentation, microbiological profile and management of complications of bone wax usage for surgical procedures at the skull base. The case records of a series of five patients who developed post-operative surgical site complications because of bone wax usage during skull base surgery were reviewed. In all five patients, persistent site-specific clinical features were noted along with intra-operative presence of excessive bone wax. Three unique cases of presentation, one with a fungal brain abscess because of Aspergillus flavus infection, another with fungal osteomyelitis because of Trichosporon beigelii infection and a third with intradural migration of bone wax into the cerebellopontine angle cistern are highlighted. The presentation of surgical site infection at the skull base because of excessive use of bone wax can be manifold. The need for testing appropriate cultures including fungal culture is highlighted.

Bone Wax as an Intra-Cavitary Fiducial for Intra-Operative Magnetic Resonance Imaging Guided Resections of Eloquent Cortex Glioma.

The extent of resection of eloquent cortex low-grade glioma is improved by intraoperative magnetic resonance imaging (IOMRI) which is faced with challenges such as difficulty in automated registration after the MRI and prolongation of operative time. We describe an easier and foolproof method of resection using bone wax as fiducial. A young male with right-frontal low-grade glioma anterior and superficial to the motor fibers was operated using IOMRI and awake craniotomy under neuromonitoring. Motor cortex mapping using phase reversal and continuous motor evoked potential (MEP) monitoring was used initially followed by continuous sub-cortical suction stimulation for deeper decompression until stimulation was seen. Bone wax in a triangular shape was placed at the suspicious margin and IOMRI was done. The tumor residue was seen anterior and deeper to the bone wax and removed subsequently. The use of bone wax as a fiducial can aid in IOMRI-guided resection of eloquent cortex glioma in awake patients.

Use of bone wax reduces blood loss and transfusion rates after total knee arthroplasty

BackgroundUnnecessary costs and complications can be reduced by minimizing blood loss and allogeneic blood transfusion in cases of total knee arthroplasty (TKA). This study evaluated the effectiveness of bone wax in reducing blood loss and transfusion rates after TKA. MethodsA total of 674 consecutive TKAs performed for degenerative osteoarthritis were retrospectively reviewed. Propensity score-matching and inverse probability of treatment weighting analyses were performed for demographics, comorbidities, use of medications, preoperative laboratory findings and radiologic prosthetic coverage of osteotomy surface. In the bone wax group, bone wax (2.5 g) was applied to the uncovered bone section around the prostheses along with the topical administration of tranexamic acid, whereas hemostasis was achieved in the control group with the topical administration of tranexamic acid. Intergroup comparisons of estimated blood loss, decreases in hemoglobin (Hb) levels, and transfusion rates were performed. ResultsThe mean estimated blood loss and volume of postoperative drainage were reduced in the bone wax group. The maximum decreases in Hb levels on postoperative days 1, 3, 5, and 7 were 1.8 ± 0.7 ml, 2.5 ± 0.8 ml, 2.7 ± 0.8 ml, and 2.8 ± 0.8 ml in the bone wax group and 2.1 ± 1.0 ml, 3.0 ± 1.2 ml, 3.1 ± 1.1 ml, and 3.2 ± 1.1 ml in the control group, respectively. The postoperative transfusion rates decreased markedly from 8.8% to 2.0% when bone wax was used. ConclusionsThe use of bone wax significantly reduced blood loss, decreased Hb levels, and the risk of transfusion.Level of evidence: Level III, Therapeutic studies.

Bone wax migrates to the orbit in a patient with a frontal sinus abnormality: a case report

BackgroundBone wax is the most widely used hemostatic bone sealant because of its availability, ease of use, immediate action, and minimal adverse effects. Several complications have been reported to be associated with the use of bone wax, such as infection, osteohypertrophy, pain, granuloma formation, allergic reaction, and thrombosis. Here, we present a rare complication, namely, bone wax migration, which developed after a craniotomy on a patient who had a frontal sinus abnormality.Case presentationA 51-year-old woman complained of pain and swelling in her left eye accompanied by difficulty opening the left eyelid after undergoing a craniotomy. An examination revealed left eye proptosis with ptosis, eyelid swelling, and increases in intraorbital pressure and intraocular pressure (IOP). According to a CT and an MRI of the orbit, we found that the intraoperative bone wax had migrated to the orbit, thereby causing compression. We also found that the basal frontal sinus of the patient was congenitally defective, which may have induced the migration of the bone wax. Given that the patient recently underwent a craniotomy and given the risks associated with orbital surgery, she refused to undergo a surgery to remove the bone wax. Thus, the patient was administered mannitol intravenously daily, accompanied by topical Timolol, to reduce the intraorbital pressure and IOP. This treatment led to a gradual decrease in IOP and intraorbital pressure, and these parameters remained stable after treatment ended. During the 6-month follow-up, the best corrected visual acuity improved, and ptosis and restricted eye movements also improved significantly.ConclusionsWe report a case of bone wax migration that developed after a craniotomy on a patient who had a congenital defect in the basal frontal sinus. Extra caution should be taken when using bone wax, and a comprehensive understanding of the patient’s intracranial anatomy is important for decreasing the incidence of bone wax migration. Additionally, when a patient presents with symptoms of ocular compression, bone wax migration should be considered in addition to typical radiological changes.

Delayed infection after using bone wax in maxillofacial surgery: A rare complication after reduction mandibuloplasty

Abstract Background Although several studies have reported various adverse reactions associated with the use of bone wax in the clinical setting, the incidence of complications after using bone wax during maxillofacial surgery via a transoral approach remains unclear. We aimed to address this scarcity of data and describe the incidence and nature of postoperative infections associated with bone wax treatment during reduction mandibuloplasty. Materials and methods A retrospective chart-review study was conducted among patients who underwent reduction mandibuloplasty performed by the same surgeon between January 2010 and December 2014. Delayed postoperative infection was diagnosed based on clinical manifestations, associated treatment strategy (additional antibiotic treatment with or without revision surgery), and results of microbiological investigation. Patients were divided into 2 groups according to whether or not bone wax had been applied during the reduction mandibuloplasty procedure. Results A total of 355 patients (44 men; average age, 31.0 years; age range, 19–53 years) underwent reduction mandibuloplasty during the study period. Of these, 19 patients (1 men; age, 26.0 ± 6.62 years) were treated with bone wax applied to the cut surface of the mandibular cancellous bone for controlling bleeding. The infection rate among patients not treated with bone wax was 1.5% (5/336; acute infection), compared to 21.0% (4/19; delayed infection) among patients treated with bone wax. The use of bone wax contributed to an increased risk of developing infection (odds ratio, 14.87 [95% confidence interval, 3.22–68.70], P Conclusion This is the first report describing the incidence of infection associated with the use of bone wax for controlling bleeding from the cancellous bone during maxillofacial surgery via a transoral approach.

Bone Wax Is Effective in Reducing Blood Loss After Total Knee Arthroplasty

BackgroundTotal knee arthroplasty (TKA) is associated with major blood loss and blood transfusion is often required. This study aimed to evaluate the efficacy of bone wax in reducing blood loss and transfusion rates after TKA. MethodsA prospective randomized controlled study that included 100 patients undergoing primary unilateral TKA with cement was conducted in a tertiary center between March 2014 and June 2014. The bone wax group received 2.5 g of bone wax, applied onto the uncovered bone around the prostheses and the nail holes before the tourniquet was released, whereas the control group had hemostasis achieved using electrocautery only. Total blood loss was calculated using the hemoglobin balance method. ResultsThere were no demographic differences between the 2 groups. The preoperative serum hemoglobin levels were comparable between the 2 groups. The drop in serum hemoglobin levels at 24 h post-TKA was 1.6 ± 0.9 and 2.1 ± 1.1 g/dL in the bone wax and control groups respectively (P = .021), while the drop in serum hemoglobin levels at 72 h post-TKA was 2.7 ± 1.1 and 3.6 ± 1.2 g/dL respectively (P = .013). Total blood loss at 72 h post-TKA was 987.9 and 1183.5 mL for the bone wax and control groups respectively (P = .017). There was no adverse event associated with the use of bone wax at the 3-month follow-up. ConclusionThe application of bone wax in TKA was safe and effective for reducing total blood loss and maintaining higher hemoglobin levels.

局部应用骨蜡和氨甲环酸在股骨头坏死全髋关节置换术中止血作用的比较

目的：比较骨蜡和氨甲环酸在股骨头坏死患者行单侧首次全髋关节置换术中止血作用的效果。方法：对2014年7月至2016年7月入住临沂市人民医院股骨头专科符合纳入和排除标准的152例需行单侧首次THA的股骨头坏死患者进行回顾性分析。按照骨蜡和氨甲环酸的使用情况将其分为4组，A组：骨蜡和氨甲环酸均未使用；B组：仅使用骨蜡；C组：仅使用氨甲环酸；D组：联合使用骨蜡和氨甲环酸。对术中失血量、术后可见失血量、术后血红蛋白变化、总失血量、输血率、临床效果等指标进行评估。结果：4组患者性别、年龄、BMI、Hb、PLT、PT、APTT、手术时间、术中失血量和术后6月髋关节Harris评分之间差异均无统计学意义(p > 0.05)；在总失血量方面，4组患者比较不全相等，差异具有统计学意义(p 0.05)；在术后可见失血量和输血率方面，4组患者比较不全相等，差异具有统计学意义(p 0.05)，C组和D组均明显低于B组，差异具有统计学意义(p 0.05)。结论：骨蜡或氨甲环酸均能明显减少股骨头坏死患者行单侧首次全髋关节置换术的失血量，但骨蜡的止血效果不如氨甲环酸；联合使用骨蜡和氨甲环酸，止血效果要优于单独使用骨蜡，但并不明显优于单独使用氨甲环酸；骨蜡和氨甲环酸没有增加刀口感染、愈合不良和静脉血栓形成等风险，不影响患者术后功能康复。 Objective: To compare and analyze the effectiveness of bone wax and tranexamic acid in reducing the blood loss associated with unilateral primary THA in patients with osteonecrosis of the femoral head. Methods: A retrospective study was carried out to analyze the cases of 152 patients who received primary unilateral THA and satisfied inclusion and exclusion criteria during July 2014 to July 2016 in Linyi City People’s Hospital of the femoral head specialist. The patients were divided into four groups according to the use of bone wax and tranexamic acid. In group A, neither bone wax nor tranexamic acid was used. In group B, bone wax was used while tranexamic acid was not. In group C, tranexamic acid was used while bone wax was not. In group D, bone wax and tranexamic acid were both used topically. The bone wax and tranexamic acid in reducing blood loss in unilateral primary THA were evaluated through assessing the intraoperative blood loss, postop-erative visible blood loss, postoperative hemoglobin change, total blood loss, blood transfusion rate, clinical effects and other indicators. Results: No difference of statistical significance (p > 0. 05) was found among the 4 groups in terms of gender, age, BMI, preoperative Hb, PLT, PT, APTT, operation time, intraoperative blood loss and hip Harris score at 6 months postoperative. The total blood loss of the 4 groups was not all the same; the difference was of statistical significance (p 0.05). The postoperative visible blood loss and blood transfusion rate of the 4 groups were not all the same; the difference was statistical significance (p 0.05). The postoperative visible blood loss and blood transfusion rate of group C and group D were significantly lower than those of group B. The difference was statistical significance (p 0.05). Conclusion: Bone wax or tranexamic acid can significantly reduce blood loss in patients with osteonecrosis of the femoral head underwent unilateral primary THA, but compared with tranexamic acid, bone wax cannot reduce the blood transfusion rate. The effectiveness of combination of both is better than bone wax alone while not better than that of tranexamic acid alone. Both bone wax and tranexamic acid will not increase the incision infection, healing and ve-nous thrombosis risk, and it does not affect postoperative functional rehabilitation.

Canalplasty for Exostoses With Maximal Skin Preservation With Temporoparietal Fascia Grafting and Use of Bone Wax for Skin Flap Protection: A Retrospective Case Series.

External auditory canal exostoses are benign, bony overgrowths that arise in patients who experience chronic cold water exposure. While considerable advancement has been made in canalplasty techniques in recent decades, many patients continue to experience prolonged healing periods and recurrent stenosis following surgery. To perform a retrospective outcomes analysis of our experience with a skin-preserving canalplasty technique with temporoparietal fascia grafting and use of bone wax for skin flap protection. Retrospective review. Thirty-four patients (41 ears) underwent canalplasty from 2008 to 2014 at a tertiary referral center. Primary outcome measures included rates of prolonged healing and restenosis, need for revision surgery, and audiometric results. Rates of intraoperative and postoperative complications were also tabulated. No patient experienced recurrent stenosis or required a revision surgery within the follow-up period. All but one patient (97%) achieved complete healing within 8 weeks. Minimal intraoperative complications were found. Statistically significant improvements in air pure tone averages and air-bone gaps were achieved. The proposed technique is a safe and effective method of canalplasty for exostoses that imparts accelerated wound healing and minimizes the rate of recurrent stenosis.

Invited Commentary

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

Use of bone wax is related to increased postoperative sternal dehiscence.

AimTo investigate the relation between use of bone wax and postoperative sternal dehiscence after cardiac surgery.Material and methodsFive thousnad three hundred and eighteen consecutive patients who underwent cardiac surgery between 1999 and 2009 were evaluated prospectively. Perioperative use of bone wax, perioperative data and outcome parameters were recorded. Multivariate logistic regression analysis was performed to define independent risk factors for postoperative sternal dehiscence.ResultsBone wax was used in a total of 1151 (21%) patients. Postoperative sternal dehiscence was detected in 88 (1.6%) patients. The postoperative sternal dehiscence rate was 1.4% in patients without bone wax and 2.5% in patients with bone wax (p = 0.001). The rate of bone wax use was 36.4% in patients with sternal dehiscence and 21.4% in patients without sternal dehiscence (p < 0.001). Independent risk factors for postoperative sternal dehiscence were defined as: age > 70 (OR = 1.9, 95% CI: 1.2-3.1, p = 0.005), chronic obstructive lung disease (OR = 2.4, 95% CI: 1.5-3.9, p < 0.001), use of bone wax (OR = 1.6, 95% CI: 1.03-2.5, p = 0.03), nonelective operation (OR = 2, 95% CI: 1.1-3.4, p = 0.009), and body mass index > 30 (OR = 2.2, 95% CI: 1.4-3.5, p < 0.001).ConclusionsOur findings suggest that use of bone wax may be associated with increased postoperative sternal dehiscence after cardiac surgery. Thus liberal use of bone wax should be restricted.

Bone Wax

Bone wax has been used for years by surgeons as a hemostatic agent to prevent bleeding from bone surfaces. Though the effectiveness of bone wax as a hemostatic agent while acting as a tamponade is well known, it is not without its complications. It has been documented in the medical literature that bone wax may remain in the body for many years as a foreign body and in some cases cause a giant cell reaction at various surgical sites. However, to the authors' knowledge, there has not been a reported case of a foreign body giant cell reaction secondary to the use of bone wax in the current podiatric literature. Two case studies are described to bring attention to the fact that bone wax can interfere with bone healing while remaining attached to bone as a foreign body and induce a giant cell reaction and local inflammatory effects in the human foot.