Bone wax as a sterile preparation for surgeryBone wax is a waxy 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 is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery ...

procedures. It is generally made of

beeswax Bee hive wax complex Beeswax (also known as 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 o ...

with a softening agent such as

paraffin Paraffin may refer to: Substances * Paraffin wax, a white or colorless soft solid (also in liquid form) that is used as a lubricant and for other applications * Liquid paraffin (drug), a very highly refined mineral oil used in cosmetics and for med ...

petroleum jelly Petroleum jelly, petrolatum (), white petrolatum, soft paraffin, or multi-hydrocarbon, CAS number 8009-03-8, is a semi-solid mixture of hydrocarbons (with carbon numbers mainly higher than 25), originally promoted as a topical ointment for i ...

and is smeared across the bleeding edge of the bone, blocking the holes and causing immediate bone hemostasis through a tamponade 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 ''The BMJ'' is a fortnightly peer-reviewed medical journal, published by BMJ Publishing Group Ltd, which in turn is wholly-owned by the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world ...

in 1892 described a formulation of "antiseptic wax" having seven parts beeswax, one part

almond The almond (''Prunus amygdalus'', Synonym (taxonomy)#Botany, syn. ''Prunus dulcis'') is a species of tree from the genus ''Prunus''. Along with the peach, it is classified in the subgenus ''Amygdalus'', distinguished from the other subgenera ...

oils, and 1%

salicylic acid Salicylic acid is an organic compound with the formula HOC6H4COOH. A colorless (or white), bitter-tasting solid, it is a precursor to and a active metabolite, metabolite of acetylsalicylic acid (aspirin). It is a plant hormone, and has been lis ...

. 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, 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 (breeding site) for post-operative

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

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
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