Ferric Sulfate Hemostasis: Effect on Osseous Wound Healing II: Wide Curettage & irrigation

By Jeansonne BG, Boggs WS, Lemon RR

Date: 10/1993
Journal: JOE

Purpose: to determine if the foreign body response and delayed healing caused by the ferric sulfate could be reduced or eliminated by curettage and irrigation of the osseous defect prior to wound closure.

N= 12 New Zealand White rabbits.

Materials/Methods:

•Bilateral incision made along the alveolar crest in the naturally edentulous space between the incisor and premolar mandibular teeth.

•Envelope flap was reflected to expose the alveolar cortical bone.

•An osseous defect (3 mm in diameter, 2 mm into cancellous bone) was created bilaterally with a #8 round bur.

•Experimental site (right): drops of ferric sulfate solution (15.5%) in the osseous defect.

        Control site (left) : Blood was allowed to fill the site.

• After 5 min the sites were gently curetted with a small bone curette and irrigated with sterile saline until all visible ferric sulfate coagulum (right) or the blood clot (left) was removed and hemorrhage reestablished. The flaps were repositioned and closed with resorbable sutures.

•Rabbits were killed 18 and 46 days post-op, specimens were sectioned and prepared for histological examination

•The sections were examined for inflammation and evidence of healing and were scored as follows: 0 complete healing with surgical site filled with healthy cancellous bone;

1 = fibrosis with dense collagen, with or without early bone formation;

2 = granulation tissue filling the surgical site, with or without chronic inflammation;

3 = acute inflammation with or without granulation tissue;

4 = abscess formation.

Most highlighted Results:

•Hemostasis was achieved in less than one minute with the ferric sulfate. •Both the experimental and control sites demonstrated active cancellous bony trabeculae with numerous plump osteoblasts.

•All 46-days specimens demonstrated either complete healing or fibrosis with bone formation.

•Both control and experimental groups scored equally in both 18 and 46 days follow-up, however histological findings in the 18-days group were not found in the controls.

Clinical significance:  Ferric sulfate provides effective hemostasis. Curettage and irrigation of the surgical osseous defect,  prior to closure, does not delay healing.