Osseous Reactions to Three Hemostatic Agents

By Ibarrola J, Bjorenson J, Austin B, Gerstein H

Date: 01/1985
Journal: JOE

Purpose:

To evaluate the rate and and osseous reactions during healing utilizing 3 different hemostatic materials

Materials/Methods:

  • N= 50 Rats; 15 in each experimental group and 5 in control group
  • Surgical defects placed in both rat tibias. In left tibia material placed for 10 minutes and then attempt to completely remove with curettage. The right tibia had material placed and wasn’t removed. Rats sacrificed at 3, 7, 14, 40, and 120 days. Histological sections evaluated for inflammation and bone repair.

Results:

  • Control: at 40 days, Bone regeneration was complete
  • Gel foam – gelatin based and is water in-soluble and biologically resorbable. Promotes platelet fracture and support fibrin clot.
  • 40 days
  • Left; Most of bony defect was filled with bone.
  • Right; Some remnants of gel foam and scattered inflammatory cells present.
  • Surgicel – oxidation of regenerated cellulose. Soluble in alkaline but not acidic or water.   Not biologically active, mechanism not understood. Mechanical in nature.
  • 40 days
  • Left; Bone formation advanced but slightly inhibited. Surgicel remnants present.
  • Right; Isolated material surrounded by bone with inflammation present.
  • Bone wax – Bees wax mixed with softening agent. Affect is purely mechanical with no affect on clotting process.
  • 40 days
  • Left; Greatly impaired bone formation with some bone trabeculation and fibrous connective tissue lined clear spaces surrounded bone wax. Inflammation still present at 120 days.
  • Right tibia had Large fibrous connective tissue lined cavities with bone wax remnants. Bone formation completely inhibited with inflammatory cells present.

Clinical Significance:

If a hemostatic agent is going to be used, Gel foam should be considered of these materials since it inhibited osseous regeneration much less than Surgicel or Bone wax.