An Unusual Complication of Bone Wax Utilization

Fahradyan, Artur; Ohanisian, Levonti; Tsuha, Michaela; Park, Matthew J; Hammoudeh, Jeffrey A.

doi:10.1097/scs.0000000000004321

Cited by 17 publications

(21 citation statements)

References 33 publications

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“…[5] However, bone wax was reported with several drawbacks that would hinder bone repair process, such as the lack of biodegradability and risk of inflammation. [6,7] On the contrary, the hemostatic property of MQ 2 T 2 relied on the effective aggregation of blood components including platelets and RBCs, which could contribute to callus formation. [24] Moreover, dysregulated inflammation response or prolonged inflammation phase was also reported to cause hindered bone formation.…”

Section: Resultsmentioning

confidence: 99%

“…[5] However, bone wax has been associated with inflammation, granuloma formation, hindered osteogenesis and even bone wax migration. [6,7] Possible substitutes of bone wax have been constructed from petroleum-based polymers and inorganic materials, [8,9] which still possess some inherent shortcomings including slow or incomplete degradation and poor effects on anti-inflammation/wound healing. Moreover, biomass-based materials had been particularly appealing for an economical and sustainable society of mankind.…”

Section: Introductionmentioning

confidence: 99%

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Biomass‐Derived Multilayer‐Structured Microparticles for Accelerated Hemostasis and Bone Repair

Liu¹,

Hu²,

Li³

et al. 2020

Advanced Science

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It is very desirable to develop advanced sustainable biomedical materials with superior biosafety and bioactivity for clinical applications. Herein, biomass-derived multilayer-structured absorbable microparticles (MQ x T y) composed of starches and plant polyphenols are readily constructed for the safe and effective treatment of bone defects with intractable bleeding by coating multiple layers of quaternized starch (Q +) and tannic acid onto microporous starch microparticles via facile layer-by-layer assembly. MQ x T y microparticles exhibit efficient degradability, low cytotoxicity, and good blood compatibility. Among various MQ x T y microparticles with distinct Q + /T − double layers, MQ 2 T 2 with outmost polyphenol layer possess the unique properties of platelet adhesion/activation and red blood cell aggregation, resulting in the best hemostatic performance. In a mouse cancellous-bone-defect model, MQ 2 T 2 exhibits the favorable hemostatic effect, low inflammation/immune responses, high biodegradability, and promoted bone repair. A proof-of-concept study of beagles further confirms the good performance of MQ 2 T 2 in controlling intractable bleeding of bone defects. The present work demonstrates that such biomass-based multilayer-structured microparticles are very promising biomedical materials for clinical use.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Biomass‐Derived Multilayer‐Structured Microparticles for Accelerated Hemostasis and Bone Repair

Liu¹,

Hu²,

Li³

et al. 2020

Advanced Science

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“…Bone wax is a mixture of sterile beeswax (70%) and Vaseline (30%), which is routinely used in neurosurgery, craniofacial surgery, orthopedics, thoracic surgery [2], and sometimes orbital surgery to reduce bleeding and to seal bony window defects. Several complications have been reported to be associated with the use of bone wax, such as infection, osteohypertrophy, pain, granuloma formation, allergic reactions, and thrombosis [1, 3, 4]. Rare complications, such as ptosis and diplopia, were reported in a recent case of craniotomy [5].…”

Section: Discussionmentioning

confidence: 99%

“…Complications related to bone wax migration are rare, and the exact incidence is unknown [1]. To our knowledge, from 1995 to 2018, 19 patients reported complications related to bone wax migration (Table 1) [1, 5–11].…”

Section: Discussionmentioning

confidence: 99%

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

Zhou

Wei

et al. 2019

BMC Ophthalmol

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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.

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Development of Biodegradable Osteopromotive Citrate‐Based Bone Putty

Tan

Gerhard

Wang

et al. 2022

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The burden of bone fractures demands development of effective biomaterial solutions, while additional acute events such as noncompressible bleeding further motivate the search for multi‐functional implants to avoid complications including osseous hemorrhage, infection, and nonunion. Bone wax has been widely used in orthopedic bleeding control due to its simplicity of use and conformation to irregular defects; however, its nondegradability results in impaired bone healing, risk of infection, and significant inflammatory responses. Herein, a class of intrinsically fluorescent, osteopromotive citrate‐based polymer/hydroxyapatite (HA) composites (BPLP‐Ser/HA) as a highly malleable press‐fit putty is designed. BPLP‐Ser/HA putty displays mechanics replicating early nonmineralized bone (initial moduli from ≈2–500 kPa), hydration induced mechanical strengthening in physiological conditions, tunable degradation rates (over 2 months), low swelling ratios (<10%), clotting and hemostatic sealing potential (resistant to blood pressure for >24 h) and significant adhesion to bone (≈350–550 kPa). Simultaneously, citrate's bioactive properties result in antimicrobial (≈100% and 55% inhibition of S. aureus and E. coli) and osteopromotive effects. Finally, BPLP‐Ser/HA putty demonstrates in vivo regeneration in a critical‐sized rat calvaria model equivalent to gold standard autograft. BPLP‐Ser/HA putty represents a simple, off‐the‐shelf solution to the combined challenges of acute wound management and subsequent bone regeneration.

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An Unusual Complication of Bone Wax Utilization

Cited by 17 publications

References 33 publications

Biomass‐Derived Multilayer‐Structured Microparticles for Accelerated Hemostasis and Bone Repair

Biomass‐Derived Multilayer‐Structured Microparticles for Accelerated Hemostasis and Bone Repair

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

Development of Biodegradable Osteopromotive Citrate‐Based Bone Putty

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