Bone wax as a sterile preparation for surgeryBone wax is a
wax
Waxes are a diverse class of organic compounds that are lipophilic, malleable solids near ambient temperatures. They include higher alkanes and lipids, typically with melting points above about 40 °C (104 °F), melting to giv ...
y substance used to help mechanically control bleeding from
bone
A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...
surfaces during
surgical
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
procedures.
It is generally made of
beeswax
Beeswax (''cera alba'') is a natural wax produced by honey bees of the genus ''Apis''. The wax is formed into scales by eight wax-producing glands in the abdominal segments of worker bees, which discard it in or at the hive. The hive work ...
with a softening agent such as
paraffin Paraffin may refer to:
Substances
* Paraffin wax, a white or colorless soft solid that is used as a lubricant and for other applications
* Liquid paraffin (drug), a very highly refined mineral oil used in cosmetics and for medical purposes
* Alkan ...
or
petroleum jelly and is smeared across the bleeding edge of the bone, blocking the holes and causing immediate
bone hemostasis through a
tamponade
Tamponade () is the closure or blockage (as of a wound or body cavity) by or as if by a tampon, especially to stop bleeding.
Tamponade is a useful method of stopping a hemorrhage. This can be achieved by applying an absorbent dressing directl ...
effect. Bone wax is most commonly supplied in sterile sticks, and usually requires softening before it can be applied.
History
A note by
Victor Horsley
Sir Victor Alexander Haden Horsley (14 April 1857 – 16 July 1916) was a British scientist and professor. He was born in Kensington, London. Educated at Cranbrook School, Kent, he studied medicine at University College London and in Berlin, G ...
published in the
British Medical Journal in 1892 described a formulation of "antiseptic wax"
having seven parts beeswax, one part
almond oils, and 1%
salicylic acid. The material was useful for controlling bleeding when pressed into the pores and channels of cut or damaged bone. The wax was sterilized by boiling and kept i
stoppered bottles This material soon became the standard of care for bleeding control in bone for general orthopedics,
craniomaxillofacial surgery, and
cardiothoracic surgery
Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart (heart disease), lungs ( lung disease), and other pleural or mediastinal str ...
, where the sternum is often split longitudinally to provide access to the heart.
Action
Ordinary bone wax is effective by virtue of its tamponade action, but is considered to have no active hemostatic properties (i.e. does not activate the
blood clotting cascade). In addition, bone wax is not soluble in the bodily fluids and thus remains at the site of implantation for long periods of time, if not indefinitely. The portion of traditional bone wax that departs the implant site is most likely carried away through the action of the foreign body response and is associated with a low-grade inflammatory response at and near the implant site. The residual product can also potentially serve as a nidus for post-operative infection.
Modern formulations
Modern day bone wax is commercially available in substantially non-absorbable formulations similar to Horsley's original composition, as well as in absorbable/resorbable formats. Most are available as a firm wax in stick form that must be softened by kneading prior to use.
More recent advances have led to the introduction of a bone hemostat in putty format. Hemostatic putties act via tamponade in the same way as the stick waxes, but are ready to use and eliminate the requirement to soften the product prior to use.
References
{{Reflist
*Horsley, V. Antiseptic Wax. Brit. M. J. 1165, 1892
Hemasorb 510(k) summaryOstene 510(k) summary
Implants (medicine)
Biomaterials
