Bone healing after median sternotomy: A comparison of two hemostatic devices

Abstract

BackgroundBone wax is traditionally used as part of surgical procedures to prevent bleeding from exposed spongy bone. It is an effective hemostatic device which creates a physical barrier. Unfortunately it interferes with subsequent bone healing and increases the risk of infection in experimental studies. Recently, a water-soluble, synthetic, hemostatic compound (Ostene®) was introduced to serve the same purpose as bone wax without hampering bone healing. This study aims to compare sternal healing after application of either bone wax or Ostene®.MethodsTwenty-four pigs were randomized into one of three treatment groups: Ostene®, bone wax or no hemostatic treatment (control). Each animal was subjected to midline sternotomy. Either Ostene® or bone wax was applied to the spongy bone surfaces until local hemostasis was ensured. The control group received no hemostatic treatment. The wound was left open for 60 min before closing to simulate conditions alike those of cardiac surgery. All sterni were harvested 6 weeks after intervention.Bone density and the area of the bone defect were determined with peripheral quantitative CT-scanning; bone healing was displayed with plain X-ray and chronic inflammation was histologically assessed.ResultsBoth CT-scanning and plain X-ray disclosed that bone healing was significantly impaired in the bone wax group (p < 0.01) compared with the other two groups, and the former group had significantly more chronic inflammation (p < 0.01) than the two latter.ConclusionBone wax inhibits bone healing and induces chronic inflammation in a porcine model. Ostene® treated animals displayed bone healing characteristics and inflammatory reactions similar to those of the control group without application of a hemostatic agent.

Evaluation of Sternal Bone Healing with Computed Tomography and a Quantitative Scoring Algorithm

“…Unlike other specialties, in which radiographic standards have been developed to assess bone healing, no standards exist to assess bony healing after a sternotomy [16][17][18][19]. The methods developed for other orthopaedic specialties have clinical implications, and may be used to determine when patients may return to normal activities or when hardware may be removed.…”

Biodegradable composite scaffolds of bioactive glass/chitosan/carboxymethyl cellulose for hemostatic and bone regeneration

“…Zhang et al (2012) suggested that an injectable nanohydroxyapatite/chitosan scaffold was a potential candidate material for regeneration of bone loss. Vestergaard et al (2010) indicated that the use of Ostene instead of bone wax could contribute to a reduction in the incidence of sternal dehiscence and chronic inflammation. Cho et al (2012) suggested the application of a thrombinsoaked, absorbable gelatin compressed sponge at the end of multilevel posterior cervical spinal surgery significantly decreased post-operative drain output.…”

“…Due to its immediacy and effectiveness of hemostasis, ease of use and low cost, it is still widely used in surgical procedures. Although it is an effective hemostatic device, which creates a physical barrier to stop bleeding, bone wax remains at the implantation site indefinitely and influences subsequent bone growth (Vestergaard et al 2010). Moreover, it has a potential risk of infection in clinical applications (Gibbs et al 2004).…”

Anterior Cervical Osteophyte Resection for Treatment of Dysphagia

“…16,22,30 Likewise, application of bone wax to the exposed cut bone helps with hemostasis and may reduce the rate of bone reaccumulation. 31,32 This is the first study to describe the use of intraoperative navigation for the resection of anterior cervical osteophytes, which has multiple advantages. Following provisional resection, intraoperative 3-D scanning can determine the amount and location of remaining osteophytes, whereas navigated probes and burs allow for real-time guidance during final bony resection.…”