Ann Thorac Surg 2008;85:1780. doi:10.1016/j.athoracsur.2007.12.024
© 2008 The Society of Thoracic Surgeons
New Technology
Invited Commentary
William L. Holman, MD
Department of Surgery, University of Alabama at Birmingham, 1530 3rd Ave S, ZRB 719, Birmingham, AL 35294-0007
(Email: wholman{at}uab.edu).
Wellisz and associates [1] compare the healing of midline sternotomies after application of bone wax vs a water-soluble polymer (Ostene, Ceremed, Inc, Los Angeles, CA) on the incised sternal surfaces. They used a rabbit model and examined healing of the sternum after 6 weeks. There was superior healing in the polymer group, and the authors suggested that cardiac surgeons use Ostene in preference to bone wax in humans.
Studies documenting results with Ostene in humans have been published for neurosurgical and craniofacial surgical applications. To date, no results have been published for the use of Ostene in humans having cardiac operations, and cardiac surgery is a somewhat special situation for several reasons. Often, one or both sides of the sternum have a compromised blood supply after dissection of the internal thoracic artery. Cardiac surgical patients routinely receive large doses of heparin intraoperatively and may have impaired coagulation for several hours after termination of bypass. The sternal retractor may crush the marrow and leave a space at the edge of the sternotomy. Coughing and upper extremity motion can disrupt the healing process and may even cause wires to tear through weak bone. The observations in this study of Wellisz and associates indicate that Ostene will likely result in superior healing of the sternum in cardiac surgical patients compared with bone wax; however, this remains to be tested.
My personal experience with Ostene is that it works reasonably well as a hemostatic agent, although it can dissolve away from the surface of the sternal marrow during a long case, especially if the patient has coagulopathic bleeding. Ostene is particularly useful for filling gaps in the sternal marrow when they exist because it will be resorbed faster than bone wax. I still use bone wax in some patients, however, and expect to do so for the foreseeable future. Furthermore, I do not expect that Ostene will prevent all the complications of sternal healing.
Several publications in the past few years have emphasized the importance of stabilizing the sternum to optimize bone healing. This is particularly true in muscular or obese patients, diabetic patients, and patients with osteoporosis/osteopenia. Double-stranded sternal wires, the use of 7 or more wires, and the use of sternal fixation plates are adjuncts that many surgeons use to prevent dehiscence and minimize infection. Ostene may be another important contributor to the optimal healing of a sternotomy; time will tell.
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References
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- Wellisz T, Armstrong JK, Cambridge J, et al. The effects of a soluble polymer and bone wax on sternal healing in an animal model Ann Thorac Surg 2008;85:1776-1780.[Abstract/Free Full Text]
Related Article
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The Effects of a Soluble Polymer and Bone Wax on Sternal Healing in an Animal Model
- Tadeusz Wellisz, Jonathan K. Armstrong, John Cambridge, Yuehuei H. An, Xuejun Wen, Christopher M. Hill, and Timothy C. Fisher
Ann. Thorac. Surg. 2008 85: 1776-1780.
[Abstract]
[Full Text]
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