title: Is bonewax safe and does it help?
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau bei Berlin, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Prziborowski
authors.forename: Martin
authors.initials: M
authors.lastname: Hartrumpf
authors.forename: Ulrich A
authors.initials: UA
authors.lastname: Stock
authors.forename: Ralf U
authors.initials: RU
authors.lastname: Kuehnel
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Albes
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D004338:Drug Combinations; D005260:Female; D006490:Hemostatics / Q000009:adverse effects; D006801:Humans; D008297:Male; D010168:Palmitates / Q000009:adverse effects; D011446:Prospective Studies; D013908:Thoracotomy; D014885:Waxes / Q000009:adverse effects
chemical_list: D004338:Drug Combinations; D006490:Hemostatics; D010168:Palmitates; D014885:Waxes; C055480:bone wax