Comparison of bone wax and chitosan usage on post-sternotomy bone healing

Amal, Ihsanul; Soebroto, Heroe; Puruhito,

doi:10.1177/0218492320984097

Cited by 4 publications

(1 citation statement)

References 10 publications

(21 reference statements)

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“…A sternotomy is a standard approach performed in almost every surgical procedure on the heart and mediastinum. 7 Sternotomy is also indicated in heart transplantation, valvular reconstruction, and pulmonary surgeries. 8, 9 Immunological dysregulation and microangiopathy are the other comorbidities associated with the hyperglycemic state, and these conditions can impair cellular regeneration and vascular perfusion to the periphery sites, such as in wound healing after surgery.…”

Section: Introductionmentioning

confidence: 99%

The outcome of sternum healing among diabetic patients undergoing open heart surgery: a literature review

2022

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Background: As part of the surgery, sternotomy is a common technique to expose the underlying organs, allowing surgeons to explore the targeted organ. Despite the benefits offered, it has several considerable complications; one of them is wound healing defect. The impairment of sternal wound healing after sternotomy could be superficial and/or deep. This condition is influenced by many factors, including diabetes mellitus, obesity, and other comorbidities. These anomalies will affect the normal healing process of the bone and other connective tissue, particularly after a major invasive event, such as in sternotomy. This study aimed to review the outcome of sternum healing among diabetics that underwent heart surgery with a sternotomy approach. Methods: Works of literature reviewed in this study were obtained from Pubmed and Google Scholar databases starting from 1992 until April 2022. The keywords used were ‘sternal wound healing’, ‘cardiac surgery’, and ‘diabetes mellitus’. An advanced search based on the exact phrases was conducted on Google Scholar. Gathered kinds of literature were then selected based on relevancy. Results: The majority of articles reviewed were observational, and most of them had CABG as a part of open heart surgery, followed by valvular and aortic surgeries and others. The incidence of impaired sternal healing and other complications (superficial and/or deep) was more commonly seen among patients with diabetes. Most studies also reported a significant correlation between DM and the incidence of impaired sternal healing, suggesting that DM was a significant predictor of it. Conclusion: Diabetes mellitus is a medical condition that must be taken into account among the candidates for open heart surgery, particularly if it is poorly controlled. The Hyperglycaemic state experienced by the patients will lead to multiorgan damage and immunological dysfunction that could affect the healing process of the sternum.

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Section: Introductionmentioning

confidence: 99%

The outcome of sternum healing among diabetic patients undergoing open heart surgery: a literature review

2022

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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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