CARDIAC SURGERY Use of bone wax is related to increased postoperative sternal dehiscence

Abstract

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.

Evaluation of the safety and efficacy of a new hemostatic powder using a quantitative surface bleeding severity scale

“…For the HP arm of the study, there was only one AE of sternal dehiscence (1 of 83 cardiothoracic patients [1.2%]) which was not attributed to the use of HP by the investigator and the CEC. In a 10‐year prospective observational study, Alhan et al found sternal dehiscence to be attributable to the use of bone wax in 2.4% of cardiac cases in which it was used . No instances of sternal non‐union were reported in patients treated with HP.…”

“…G + T was selected as the control agent for several reasons. G + T is one of the most frequently used hemostatic agents in the United States . The components of the control article are very similar to those of the investigational device (porcine gelatin with recombinant human thrombin vs. porcine collagen with human pooled plasma thrombin, respectively).…”

Bone wax extrusion through postauricular wounds: A case series

“…The reaction is characterized by giant cells, plasma cells, fibrous tissue, and a lack of bone formation, which eventually may trigger an allergic reaction or granuloma formation. 5 This histologically is seen in the two cases described above. In vivo studies have demonstrated that bone wax also delays wound-healing by inhibiting osteogenesis, 3 and it induces inflammation by affecting bacterial clearance in cancellous bone.…”

“…Granuloma formation and foreign body reaction from bone wax have been described in the orbit, nasal cavity, mastoid, cerebellopontine angle, and foot. The reaction is characterized by giant cells, plasma cells, fibrous tissue, and a lack of bone formation, which eventually may trigger an allergic reaction or granuloma formation . This histologically is seen in the two cases described above.…”

“…2 It is commonly used in cardiac, orthopedic, neurosurgical, craniofacial, and mastoid surgeries. [2][3][4][5] However, rare cases of granuloma, thrombosis, allergic reaction, and impaired bone healing have been reported. [2][3][4][5][6][7][8][9] To date, there are no reports of bone wax extrusion.…”