User:Horsely/sandbox

Hemostatic Tamponades For Orthopedic Use

Background.
A note published in the British Medical Journal in 1892 by Victor Horsley 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 the bleeding site to control bleeding as a tamponade. Specifically, the soft wax provided a dam-like action for blocking bleeding pores and channels. It was sterilized by boiling and kept in stoppered bottles. This material soon became the standard of care for control of bleeding in bone and was also used in fields of surgery, such orthopedics, craniomaxillofacial and in 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 it has no inherent active hemostatic properties (ie does not activate the clotting cascade). In addition, it is not soluble in the bodily fluids and thus remains at the site of implantation for long periods of time. The portion which is eventually is removed is probably carried away through the action of the foreign body response and tends to promote infection and in itself causes a low grade inflammatoryreaction in the tissues about the site of implantation.

Modern day bone wax is commercially available in substantially non-absorbable formulations similar to Horsely's original composition, and in absorbable formats as well. Many of these waxes are provided as a firm wax in stick form that must be softened by kneading prior to use. More recent advances have lead to the introduction of bone hemostats in putty format. Putties are hemostatic through tamponade in the same way as the firm waxes, but are provided 'ready to use' and eliminate the need to soften the product before application.

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

Absorbable/Resorbable Putties
HEMASORB

Format and composition Orthocon Hemasorb Resorbable Hemostatic Bone Putty is a sterile, soft, moldable, biocompatible, absorbable material of putty-like consistency. The material is a mixture of calcium stearate, Vitamin E acetate, and liquid surfactant. It is virtually odorless, off-white in color and can be spread easily with minimal adhesion to surgical gloves. The bone putty requires no kneading prior to application and does not soften appreciably at body temperature.

Absorbable Firm Waxes

REFERENCES [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2420380/pdf/brmedj08849-0041c.pdf Horsley, V.: Antiseptic Wax. Brit. M. J., I: II65, I892].