Is Bonewax Safe and Does It Help?

Prziborowski, Jörg; Hartrumpf, Martin; Stock, Ulrich A.; Kuehnel, Ralf Uwe; Albes, Johannes M.

doi:10.1016/j.athoracsur.2007.10.036

Cited by 37 publications

(35 citation statements)

References 18 publications

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“…Level of concern has varied regarding to the risk of DSWI due to use of bone wax. Animal studies showed an increased risk of Staphylococcus aureus infections [53] ; however, a prospective, randomized trial of 400 patients found no detrimental effects [54] . Finally, adherence to basic principles of care contributes to reduce the risk of DSWI.…”

Section: Risk Factorsmentioning

confidence: 99%

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Cotogni

Barbero

Rinaldi

2015

WJCCM

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Despite many advances in prevention and perioperative care, deep sternal wound infection (DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospital mortality and also on mid-and long-term survival. The permanent high impact of this complication is partially related to the increasing proportion of patients at highrisk for infection, as well as to the many patient and surgical risk factors involved in the pathogenesis of DSWI. The prophylactic antibiotic therapy is one of the most important tools in the prevention of DSWI. However, the choice of antibiotic, the dose, the duration, the adequate levels in serum and tissue, and the timing of antimicrobial prophylaxis are still controversial. The treatment of DSWI ranges from surgical revision with primary closure to surgical revision with open dressings or closed irrigation, from reconstruction with soft tissue flaps to negative pressure wound therapy (NPWT). However, to date, there have been no accepted recommendations regarding the best management of DSWI. Emerging evidence in the literature has validated the efficacy and safety of NPWT either as a single-line therapy, or as a "bridge" prior to final surgical closure. In conclusion, the careful control of patient and surgical risk factors -when possible, the proper antimicrobial prophylaxis, and the choice of validated techniques of treatment could contribute to keep DSWIs at a minimal rate. Core tip: Intensivists and cardiothoracic surgeons are commonly worried about surgical site infections due to increasing length of stay, costs, and mortality. In particular, deep sternal wound infection (DSWI) is a worrying complication after cardiac surgery, with a still relevant incidence. Unfortunately, DWSI appearance is related to a wide number of both patient and surgical factors. This review may be useful for guiding physicians to the knowledge of main risk factors and the choice of the appropriate management of DWSIs with the aim of reducing the rate of this potentially devastating complication in cardiac surgery patients.Cotogni P, Barbero C, Rinaldi M. Deep sternal wound infection after cardiac surgery: Evidences and controversies. World J Crit Care Med 2015; 4(4): 265-273 Available from: URL: http:// www.wjgnet.com/2220-3141/full/v4/i4/265.htm DOI: http:// dx.doi.org/10.5492/wjccm.v4.i4.265 INTRODUCTIONDeep sternal wound infection (DSWI) is one of the most complex and potentially devastating complications following median sternotomy in cardiac surgery with a significant impact on both patient prognosis and hospital budgets [1][2][3][4][5] . Despite many advances in prevention, it still remains significant and ranges between 0.5% and 6.8% [6][7][8][9][10] , with in-hospital mortality rates between 7% and 35% [2,3,7,9,[11][12][13] . Moreover, mid-and long-term survival is significantly reduced in patients that have experienced DSWI. By the end of the first year, Filsoufi et al [6] found a 15% absolute survival difference between patients ...

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Section: Risk Factorsmentioning

confidence: 99%

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Cotogni

Barbero

Rinaldi

2015

WJCCM

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“…Thus the osteogenesis and the wound healing are more important than any other site of bone wax implementation. It is reported that persistent sternal nonunion and chronic inflammatory reactions with the presence of residual bone wax exist up to 10 years after the operation [2–4]. Postoperative sternal dehiscence was detected more than 2 times in patients with bone wax in this study.…”

Section: Discussionmentioning

confidence: 45%

“…The hemostatic effect of bone wax is mainly related to its physical blocking of the holes in the bone and stopping the blood flow from damaged vessels into the bone. However, the literature data do not support a reduction of blood or blood product consumption as a result of a presumably decreased perioperative blood loss when using bone wax [4]. This study also was unable to demonstrate a benefit in terms of drainage and use of blood products with bone wax.…”

Section: Discussionmentioning

confidence: 57%

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

Alhan

Aritürk

Şenay

et al. 2014

kitp

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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.

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“…[34] Rarely bone wax causes side effects, some of which are inhibition of bone healing, increased infection rates and chronic inflammatory reactions. [45] These side effects are observed in the in vivo utilisation of bone wax.…”

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confidence: 99%