Department of Thoracic, Cardiac, and Vascular Surgery, Soetomo General Hospital, Airlangga University, Surabaya, East Java, Indonesia.
Asian Cardiovasc Thorac Ann. 2021 Mar;29(3):203-207. doi: 10.1177/0218492320984097. Epub 2020 Dec 22.
Sternotomy is a standard approach performed in almost every surgical procedure on the heart and mediastinum. Effective hemostasis of the sternum is required to keep the operative field dry, avoid excessive blood transfusions during surgery, and prevent reoperation due to massive postoperative bleeding, which can further increase morbidity and mortality in patients. Bone wax is a mechanical hemostat commonly used after sternotomy and has been known to affect bone healing, trigger chronic inflammatory reactions, and increase the rate of infection. The application of chitosan, which has intrinsic hemostat ability, as hemostatic material is believed to improve bone healing following sternotomy. This study aimed to compare the effectiveness of bone wax and chitosan on bone healing after sternotomy.
Median sternotomies were performed on 2 groups of New Zealand White rabbits. Each group of 16 animals received either bone wax or chitosan powder as hemostatic material. The degree of bone healing, the number of foreign-body giant cells, and the number of osteoblasts were evaluated after 6 weeks.
Radiographs showed that significantly more animals in the chitosan group had total sternal healing ( = 0.033). Histopathology revealed that the number of foreign-body giant cells was significantly less ( 0.036) and the number of osteoblasts was significantly greater ( < 0.0001) in the group of animals that received chitosan.
The use of chitosan as hemostatic material can promote better bone healing compared to bone wax.
胸骨切开术是几乎每一种心脏和纵隔外科手术都要进行的标准方法。为了保持手术视野干燥、避免手术中过度输血以及防止因大量术后出血而需要再次手术，需要有效地止血胸骨，这可以进一步降低患者的发病率和死亡率。骨蜡是一种在胸骨切开术后常用的机械止血剂，已知它会影响骨愈合、引发慢性炎症反应并增加感染率。作为止血材料的壳聚糖具有内在的止血能力，其应用被认为可以改善胸骨切开术后的骨愈合。本研究旨在比较骨蜡和壳聚糖在胸骨切开术后骨愈合方面的效果。
对两组新西兰白兔进行正中胸骨切开术。每组 16 只动物分别使用骨蜡或壳聚糖粉末作为止血材料。在 6 周后评估骨愈合程度、异物巨细胞数量和成骨细胞数量。
X 线片显示，壳聚糖组中有更多的动物完全愈合胸骨（=0.033）。组织病理学显示，壳聚糖组的异物巨细胞数量明显减少（=0.036），成骨细胞数量明显增加（<0.0001）。
与骨蜡相比，壳聚糖作为止血材料可促进更好的骨愈合。
