The embolization of bone wax from sternotomy incisions

Area of Science:

• Cardiovascular Surgery
• Surgical Materials
• Infectious Disease

Background:

• Bone wax is a hemostatic agent used in sternotomy incisions.
• Concerns exist regarding potential complications associated with bone wax, including sternal osteomyelitis caused by Mycobacterium fortuitum.

Purpose of the Study:

• To evaluate the effects of discontinuing bone wax use in sternotomy incisions.
• To investigate the potential for bone wax to embolize to the lungs and contribute to pulmonary complications.

Main Methods:

• Retrospective study of 400 patients comparing outcomes with and without bone wax.
• Animal model study using radioactively tagged bone wax to assess lung deposition.

Main Results:

• Discontinuation of bone wax did not increase postoperative bleeding (chest tube drainage, reoperation rates).
• A significant decrease in pulmonary complications was observed after stopping bone wax use.
• Animal studies demonstrated rapid embolization of bone wax to peripheral lung tissue.

Conclusions:

• Bone wax can be safely discontinued in sternotomy incisions without increasing bleeding.
• Bone wax embolization to the lungs is a probable mechanism for pulmonary complications after cardiac surgery.
• Avoiding bone wax may reduce postoperative pulmonary morbidity.