The effects of a soluble polymer and bone wax on sternal healing in an animal model.
OBJECTIVE
This study compares the effects of a soluble polymer hemostatic material and bone wax on sternal bone healing.


METHODS
Median sternotomies were performed on 20 New Zealand White rabbits, and sufficient polymer (Ostene; Ceremed Inc, Los Angeles CA) or bone wax (Bone Wax; Ethicon Inc, Somerville, NJ) was applied to achieve bone hemostasis. After 6 weeks, sternal healing was assessed using roentgenograms, histology, and mechanical strength testing.


RESULTS
Roentgenograms revealed normal bone healing in the polymer-treated group and nonunion in the bone wax group. Histology showed normal bone healing in the polymer group, with fibrotic scar tissue and the absence of new bone formation in the bone wax group. Mechanical strength testing showed that polymer-treated sternal segments were twice as strong as those treated with bone wax. They had a significantly higher flexural strength (2.53 +/- 0.43 vs. 1.29 +/- 0.37 megapascal [MPa]; p < 0.001) and Young's modulus (0.315 +/- 0.056 vs 0.146 +/- 0.031 MPa; p < 0.001).


CONCLUSIONS
The application of the polymer hemostatic material to the sternum resulted in significantly stronger union compared with the use of bone wax.
Wellisz
Tadeusz
T
Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. tadeusz@wellisz.com
Armstrong
Jonathan K
JK
Cambridge
John
J
An
Yuehuei H
YH
Wen
Xuejun
X
Kang
Qian
Q
Hill
Christopher M
CM
Fisher
Timothy C
TC
D000818:Animals; D004195:Disease Models, Animal; D004338:Drug Combinations; D005260:Female; D006490:Hemostatics / Q000494:pharmacology*; D010012:Osteogenesis / Q000187:drug effects* / Q000502:physiology; D010168:Palmitates / Q000494:pharmacology*; D020442:Poloxamer / Q000494:pharmacology*; D011817:Rabbits; D013249:Sternum / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013537:Sutures; D013718:Tensile Strength / Q000187:drug effects / Q000502:physiology; D014885:Waxes / Q000494:pharmacology*; D014945:Wound Healing / Q000187:drug effects / Q000502:physiology
D004338:Drug Combinations; D006490:Hemostatics; C512681:Ostene; D010168:Palmitates; D014885:Waxes; D020442:Poloxamer; C055480:bone wax