Skip to main content

Advertisement

Log in

The effects of surgicel and bone wax hemostatic agents on bone healing: An experimental study

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background: The biological effects of hemostatic agents on the physiological healing process need to be tested. The aim of this study was to assess the effects of oxidized cellulose (surgicel) and bone wax on bone healing in goats’ feet.

Materials and Methods: Three congruent circular bone defects were created on the lateral aspects of the right and left metacarpal bones of ten goats. One defect was left unfilled and acted as a control; the remaining two defects were filled with bone wax and surgicel respectively. The 10 animals were divided into two groups of 5 animals each, to be sacrificed at the 3rd and 5th week postoperatively. Histological analysis assessing quality of bone formed and micro-computed tomography (MCT) measuring the quantities of bone volume (BV) and bone density (BD) were performed. The results of MCT analysis pertaining to BV and BD were statistically analyzed using two-way analysis of variance (ANOVA) and posthoc least significant difference tests.

Results: Histological analysis at 3 weeks showed granulation tissue with new bone formation in the control defects, active bone formation only at the borders for surgicel filled defects and fibrous encapsulation with foreign body reaction in the bone wax filled defects. At 5 weeks, the control and surgicel filled defects showed greater bone formation; however the control defects had the greatest amount of new bone. Bone wax filled defects showed very little bone formation. The two-way ANOVA for microcomputed tomography results showed significant differences for BV and BD between the different hemostatic agents during the two examination periods.

Conclusion: Surgicel has superiority over bone wax in terms of osseous healing. Bone wax significantly hinders osteogenesis and induces inflammation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Samudrala S. Topical hemostatic agents in surgery: A surgeon’s perspective. AORN J 2008;88:S2–11.

    Article  Google Scholar 

  2. Achneck HE, Sileshi B, Jamiolkowski RM, Albala DM, Shapiro ML, Lawson JH. A comprehensive review of topical hemostatic agents: Efficacy and recommendations for use. Ann Surg 2010;251:217–28.

    Article  Google Scholar 

  3. Lawson JH. The clinical use and immunologic impact of thrombin in surgery. Semin Thromb Hemost 2006;32 Suppl 1:98–110.

    Article  Google Scholar 

  4. Katre C, Triantafyllou A, Shaw RJ, Brown JS. Inferior alveolar nerve damage caused by bone wax in third molar surgery. Int J Oral Maxillofac Surg 2010;39:511–3.

    Article  CAS  Google Scholar 

  5. Eser O, Cosar M, Aslan A, Sahin O. Bone wax as a cause of foreign body reaction after lumbar disc surgery: A case report. Adv Ther 2007;24:594–7.

    Article  Google Scholar 

  6. Oto A, Remer EM, O’Malley CM, Tkach JA, Gill IS. MR characteristics of oxidized cellulose (Surgicel). AJR Am J Roentgenol 1999;172:1481–4.

    Article  CAS  Google Scholar 

  7. Dogan S, Kocaeli H, Doygun M. Oxidised regenerated cellulose as a cause of paraplegia after thoracotomy: Case report and review of the literature. Spinal Cord 2005;43:445–7.

    Article  CAS  Google Scholar 

  8. Finn MD, Schow SR, Schneiderman ED. Osseous regeneration in the presence of four common hemostatic agents. J Oral Maxillofac Surg 1992;50:608–12.

    Article  CAS  Google Scholar 

  9. Schonauer C, Tessitore E, Barbagallo G, Albanese V, Moraci A. The use of local agents: Bone wax, gelatin, collagen, oxidized cellulose. Eur Spine J 2004;13 Suppl 1:S89–96.

    Article  Google Scholar 

  10. Dai KR, Xu XL, Tang TT, Zhu ZA, Yu CF, Lou JR, et al. Repairing of goat tibial bone defects with BMP-2 gene-modified tissue-engineered bone. Calcif Tissue Int 2005;77:55–61.

    Article  CAS  Google Scholar 

  11. Ott SM. Histomorphometric measurements of bone turnover, mineralization, and volume. Clin J Am Soc Nephrol 2008;3 Suppl 3:S151–6.

    Article  Google Scholar 

  12. Wagner WR, Pachence JM, Ristich J, Johnson PC. Comparative in vitro analysis of topical hemostatic agents. J Surg Res 1996;66:100–8.

    Article  CAS  Google Scholar 

  13. Ellis H. Horsley’s wax. J Perioper Pract 2007;17:82–3.

    Article  Google Scholar 

  14. Brignol L, Guyot L, Richard O, Chossegros C. An unusual jugal abscess after third molar extraction: A complication of hemostatic wax. Rev Stomatol Chir Maxillofac 2007;108:150–2.

    Article  CAS  Google Scholar 

  15. Lavigne M, Boddu Siva Rama KR, Doyon J, Vendittoli PA. Bone-wax granuloma after femoral neck osteoplasty. Can J Surg 2008;51:E58–60.

    PubMed  PubMed Central  Google Scholar 

  16. Sudmann B, Bang G, Sudmann E. Histologically verified bone wax (beeswax) granuloma after median sternotomy in 17 of 18 autopsy cases. Pathology 2006;38:138–41.

    Article  Google Scholar 

  17. Wellisz T, An YH, Wen X, Kang Q, Hill CM, Armstrong JK. Infection rates and healing using bone wax and a soluble polymer material. Clin Orthop Relat Res 2008;466:481–6.

    Article  Google Scholar 

  18. Kamide T, Nakada M, Hirota Y, Hayashi Y, Hayashi Y, Uchiyama N, et al. Skull osteohypertrophy as a complication of bone wax. J Clin Neurosci 2009;16:1658–60.

    Article  Google Scholar 

  19. Wellisz T, Armstrong JK, Cambridge J, An YH, Wen X, Kang Q, et al. The effects of a soluble polymer and bone wax on sternal healing in an animal model. Ann Thorac Surg 2008;85:1776–80.

    Article  Google Scholar 

  20. Alves Júnior L, Vicente WV, Ferreira CA, Manso PH, Arantes LR, Pinheiro KS, et al. Surgicel packing and an erroneous diagnosis of mediastinitis in a neonate. Tex Heart Inst J 2010;37:116–8.

    PubMed  Google Scholar 

  21. Azmy AF. Oxidized cellulose haemostat mimicking a possible recurrence of neuroblastoma. BJU Int 2001;88:295–6.

    Article  CAS  Google Scholar 

  22. Gao HW, Lin CK, Yu CP, Yu MS, Chen A. Oxidized cellulose (Surgicel) granuloma mimicking a primary ovarian tumor. Int J Gynecol Pathol 2002;21:422–3.

    Article  Google Scholar 

  23. Herbert HA, Morton RP. Sialocele after parotid surgery: Assessing the risk factors. Otolaryngol Head Neck Surg 2012;147:489–92.

    Article  Google Scholar 

  24. Ibrahim MF, Aps C, Young CP. A foreign body reaction to surgicel mimicking an abscess following cardiac surgery. Eur J Cardiothorac Surg 2002;22:489–90.

    Article  Google Scholar 

  25. Royds J, Kieran S, Timon C. Oxidized cellulose (Surgicel) based reaction post thyroidectomy mimicking an abscess: A case report. Int J Surg Case Rep 2012;3:338–9.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nasser Nooh.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nooh, N., Abdullah, W.A., Grawish, M.EA. et al. The effects of surgicel and bone wax hemostatic agents on bone healing: An experimental study. IJOO 48, 319–325 (2014). https://doi.org/10.4103/0019-5413.129451

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/0019-5413.129451

Key words

Navigation