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Original Articles: Cardiovascular

Is Bonewax Safe and Does It Help?

Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau bei Berlin, Germany

Accepted for publication October 10, 2007.

^_* Address correspondence to Dr Albes, Department of Cardiovascular Surgery, Heart Center Brandenburg, Ladeburger Strasse 17, Bernau bei Berlin 16321, Germany (Email: j.albes{at}immanuel.de).

Background: Bonewax is routinely used to seal sternal edges after median sternotomy. Adverse effects on sternal healing, however, have been proclaimed although clear evidence does not exist. We performed a study on coronary bypass patients with or without bonewax application to verify negative effects and risk factors for early rethoracotomy, wound healing problems, and mediastinitis.

Methods: In a prospectively randomized study on 400 patients undergoing isolated coronary bypass surgery, 200 patients with (bonewax) and 200 patients without bonewax (nonwax) application after median sternotomy were compared. Blood product consumption, early rethoracotomy, sternum stabilization, mediastinitis, and early mortality were compared. Risk factors such as age, sex, diabetes mellitus, and bonewax were analyzed by means of logistical regression analysis.

Results: Blood product consumption was almost identical in both groups (red blood cells, 3.9 ± 4.7 units in the bonewax group; 3.8 ± 3.4 units in the nonwax patients; fresh frozen plasma, 0.5 ± 1.6 units versus 0.5 ± 1.3 units; platelet concentrates, 0.07 ± 0.3 units versus 0.04 ± 0.2 units). Early rethoracotomy (bonewax 6.5%; nonwax 5%), sternal stabilization (bonewax 3%; nonwax 3%), and mediastinitis (bonewax 1%; nonwax 0.5%) did not differ significantly. Early mortality was 2.5% in the bonewax group and 0.5% in the nonwax cohort. Bonewax did not appear as an independent risk factor for adverse outcome.

Conclusions: Negative effects of bonewax on the percentage of postoperative complications and outcome were not shown. However, positive effects such as a reduction of blood product substitution were also not observed. Using bonewax on sternal edges is obviously safe but not particularly beneficial.