Ohno Tsukasa, Suenaga Hiroto, Yamawaki-Ogata Aika, Kanie Kei, Kato Ryuji, Uto Koichiro, Ebara Mitsuhiro, Ito Hideki, Narita Yuji, Usui Akihiko, Mutsuga Masato
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Tokai National Higher Education and Research System, Nagoya, Japan.
Department of Basic Medicinal Sciences, Graduate School of Pharmaceutical Sciences, Nagoya University, Tokai National Higher Education and Research System, Nagoya, Japan.
Interdiscip Cardiovasc Thorac Surg. 2023 Nov 2;37(5). doi: 10.1093/icvts/ivad170.
The use of bone wax (BW) is controversial for sternal haemostasis because it increases the risk of wound infection and inhibits bone healing. We developed new waxy bone haemostatic agents made from biodegradable polymers containing peptides and evaluated them using rabbit models.
We designed 2 types of waxy bone haemostatic agents: peptide wax (PW) and non-peptide wax (NPW), which used poly(ε-caprolactone)-based biodegradable polymers with or without an osteogenesis-enhancing peptide, respectively. Rabbits were randomly divided into 4 groups based on treatment with BW, NPW, PW or no treatment. In a tibial defect model, the bleeding amount was measured and bone healing was evaluated by micro-computed tomography over 16 weeks. Bone healing in a median sternotomy model was assessed for 2 weeks using X-ray, micro-computed tomography, histological examination and flexural strength testing.
The textures of PW and NPW (n = 12 each) were similar to that of BW and achieved a comparable degree of haemostasis. The crevice area of the sternal fracture line in the BW group was significantly larger than that in other groups (n = 10 each). The PW group demonstrated the strongest sternal flexural strength (n = 10), with complete tibial healing at 16 weeks. No groups exhibited wound infection, including osteomyelitis.
Waxy biodegradable haemostatic agents showed satisfactory results in haemostasis and bone healing in rabbit models and may be an effective alternative to BW.
骨蜡（BW）用于胸骨止血存在争议，因为它会增加伤口感染风险并抑制骨愈合。我们开发了由含肽的可生物降解聚合物制成的新型蜡质骨止血剂，并使用兔模型对其进行了评估。
我们设计了2种蜡质骨止血剂：肽蜡（PW）和非肽蜡（NPW），它们分别使用基于聚（ε-己内酯）的可生物降解聚合物，其中一种含有成骨增强肽，另一种不含。根据BW、NPW、PW治疗或不治疗，将兔子随机分为4组。在胫骨缺损模型中，测量出血量，并在16周内通过微型计算机断层扫描评估骨愈合情况。使用X射线、微型计算机断层扫描、组织学检查和弯曲强度测试，对正中胸骨切开术模型中的骨愈合情况进行了2周的评估。
PW和NPW（每组n = 12）的质地与BW相似，止血程度相当。BW组胸骨骨折线的缝隙面积明显大于其他组（每组n = 10）。PW组胸骨弯曲强度最强（n = 10），胫骨在16周时完全愈合。没有一组出现伤口感染，包括骨髓炎。
蜡质可生物降解止血剂在兔模型的止血和骨愈合方面显示出令人满意的结果，可能是BW的有效替代品。
