Bone Wax

Bone Wax

A note by Victor Horsley 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 bleeding control in cut or damaged bone where it could be pressed into bleeding pores and channels. The wax was sterilized by boiling and kept in stoppered bottles. This material soon became the standard of care for bleeding control in bone for general orthopedics, craniomaxillofacial and cardio-thoracic surgery where the sternum is often split longitudinally to provide access to the heart.

Ordinary bone wax is effective by virtue of its tamponade action, but is considered to have no active hemostatic properties (ie 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 which 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 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 of these waxes 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.

Examples of commercially available hemostatic tamponades are shown in the table below