Bone Wax

Last edit by Alaric Steinmetz on

Synonyms: Bone wax, Cera per ossa, Beenwas, Cera para huesos

Bone wax is used primarily for osseous hemostasis in neurosurgery. It is a sterile mixture of paraffin, beeswax, and plasticizers. The proportion of beeswax is generally 85–90 %1. The mixture is sterilized with gamma radiation and should be stored at no more than 25 degrees Celsius. If bone wax is stored correctly, it has a shelf life of up to 5 years. Commercially available bone wax packages usually weigh 2.5 g per package2.

Mechanism of action

Hemostasis using bone wax occurs through a purely mechanical mechanism without a biochemical effect. Bone wax is not resorbed.

Imaging

On postoperative MRI imaging, applied bone wax appears as air.

Complications of bone wax

Bone wax is routinely used in neurosurgical procedures but should nevertheless be used with caution. The use of bone wax increases the infection rate because the bone at this site loses its ability to clear bacteria34. Bone wax also impairs bone healing; this should be considered particularly in spinal procedures in which bone fusion is desired5. Various complications may also result from mechanical compression caused by the bone wax6.

Figure

Bone wax packaging
Original bone wax packaging

Ethicon bone wax
Unopened 2,5 g package of bone wax manufactured by Ethicon.

Opened bone wax
Opened 2,5g package of bone wax manufactured by Ethicon.

References

    1. Das, Joe M. "Bone wax in neurosurgery: a review." World neurosurgery 116 (2018): 72-76. ↩ ↩ ↩ ↩ ↩ ↩ ↩ ↩ ↩ ↩

    2. Johnson P, Fromm D. Effects of bone wax on bacterial clearance. Surgery. 1981 Feb;89(2):206-209. ↩ ↩

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