Related Experiment Video
Updated: May 7, 2026
Hemocompatibility Testing of Blood-Contacting Implants in a Flow Loop Model Mimicking Human Blood Flow
Published on: March 5, 2020
Effect of hemostatic material on sternal healing after cardiac surgery
Rikke F Vestergaard1, Per H Nielsen2, Kim A Terp2
1Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark.
Insights
A new water-soluble polymer wax (WSW) aids sternal healing after cardiac surgery, unlike traditional bone wax (BW). WSW offers a better alternative for topical sternal hemostasis, improving patient outcomes.
Area of Science:
- Surgical Innovation
- Biomaterials Science
- Orthopedic Surgery
Background:
- Postoperative sternal infection and dehiscence are significant complications following cardiac surgery.
- Predisposing factors for sternal healing complications are not fully understood.
- Topical hemostatic agents like bone wax (BW) and water-soluble polymer wax (WSW) may influence sternal healing.
Purpose of the Study:
- To investigate the impact of topical hemostatic agents, specifically BW and WSW, on sternal healing.
- To compare the efficacy of WSW versus BW in patients undergoing cardiac surgery.
Main Methods:
- Randomized controlled trial involving 50 patients undergoing elective cardiac surgery.
- Patients were randomized to receive either BW or WSW for sternal hemostasis.
- A control group of 25 patients without sternal hemostasis was included.
- Radiologic bone healing assessed by CT scans at 3 and 6 months.
- Quality of life and pain evaluated using Short Form-36 and Visual Analogue Scale questionnaires.
Main Results:
- Bone healing was significantly impaired in the BW group compared to both control and WSW groups at 3 and 6 months (p < 0.0001).
- No complete radiologic healing observed at 3 months in any group.
- Radiologic bone healing positively correlated with physical functioning scores (p < 0.001).
- Pain scores were low and not significantly different between groups.
Conclusions:
- Water-soluble polymer wax (WSW) demonstrates superior performance in promoting sternal healing compared to bone wax (BW).
- WSW is a viable and potentially beneficial alternative for topical hemostasis on the sternum during cardiac surgery.
Background:
Postoperative sternal infection and dehiscence cause increased morbidity, mortality, and socioeconomic costs as well as patient discomfort and pain. Some predisposing factors have been uncovered but others remain uninvestigated. Among these are the influence of topical hemostatic agents such as bone wax (BW) and Ostene (Ceremed Inc, Los Angeles, CA) a new, water-soluble polymer wax (WSW). The object of this study was to investigate the impact of topical hemostatic agents on sternal healing in patients.
Methods:
In total, 50 patients subjected to elective cardiac surgery and requiring intraoperative hemostatic treatment were randomized to 1 of 2 treatment groups: BW or WSW. Twenty-five patients without need for sternal hemostasis constituted a control group. The doctors analyzing the endpoints were blinded to the treatment. Radiologic bone healing was assessed by a radiologist using computed tomography at 3 and 6 months postoperatively. Quality of life and bodily pain was assessed by questionnaires (Short Form-36 and Visual Analogue Scale).
Results:
No patients displayed complete radiologic healing at 3 months. Bone healing (evaluated semi-quantitatively at a score from 0 to 10) was significantly impaired in the BW group compared with both the control and WSW groups at both 3 and 6 months postoperatively (p < 0.0001). Radiologic bone healing was positively correlated with physical functioning score (Short Form-36) (p < 0.001). Pain scores were generally low (<1) at both 3 and 6 months with no significant difference between study groups.
Conclusions:
The results from this study suggest that WSW provides a useful alternative to BW when topic hemostasis on the sternum is required.
More Related Videos
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:05Introduction to Hemostasis
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized,...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:20Extrinsic and Intrinsic Pathways of Hemostasis
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...
01:26Cardiac Catheterization IV: Nursing Management