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J Thorac Cardiovasc Surg 1994;108:1151-1152
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

Use of microfibrillar collagen hemostat (Avitene) and thrombin to achieve hemostasis after median sternotomy

Department of Surgery
West Virginia University School of Medicine
Robert C. Byrd Health Sciences Center North
Morgantown, WV 26506-9238

To the Editor:

Several techniques to control bleeding before closure of the median sternotomy after cardiac procedures have been used, including bone wax, microfibrillation collagen, and electrocautery alone ^{1, 2} Our method involves mixing biodegradable materials in a sterile manner on the surgical field.

Previously, we placed 20,000 units of thrombin mixed with 10 ml of diluent into a Gelfoam jar (Upjohn Co., Kalamazoo, Mich.), replaced the lid, agitated the contents, and then placed the mixture onto the sterile table. Because of the difficulty of removing the Gelfoam powder, the possibility of contamination, and the previous short supply, we changed our materials and now use a solution of microfibrillar collagen hemostat (Avitene; Alcon, Inc., Humacao, Puerto Rico) and thrombin made in the following fashion. Two sterile jars of microfibrillar collagen hemostat (1 gm each) are placed on the sterile field and mixed with 10,000 units of thrombin and 10 ml of supplied diluent. The contents are agitated on the sterile field and subsequently applied to the sternum by the surgeon.

Animal experiments have shown that when radioactive bone wax is used for hemostasis of the sternum, evidence of peripheral lung embolization is found. ¹ Bone wax has also been implicated in delayed healing of the sternum, as well as allergic reactions and osteomyelitis. ^{3, 4} Because of these complications, we began using an absorbable Gelfoam powder/thrombin mixture and then switched to a microfibrillar collagen hemostat/thrombin mixture, for the reasons previously cited. The advantages of the latter mixture are that it can be mixed entirely on the sterile field with minimal possibility of contamination and it forms a thicker paste that is totally absorbable. The disadvantage is that it costs more. We have used this technique safely in our patients without evidence of infection or excessive bleeding from the sternum.

References

1. Robicsek F, Masters TN, Littman L, et al. The embolization of bone wax from sternotomy incision. Ann Thorac Surg 1981;31:357-9.[Abstract]
   
2. Blanche C, Chaux A. The use of absorbable microfibrillation collagen to control sternal bone marrow bleeding. Int Surg 1988;73:42-3.[Medline]
   
3. Nelson DR, Buxton TB, Lun QN, Rissing JP. The promotional effect of bone wax on experimental Staphylococcus aureus osteomyelitis. J THORAC CARDIOVASC SURG 1990;99:977-80.[Abstract]
   
4. Jones RH. Invited letter concerning: The promotional effect of bone wax on experimental Staphylococcus aureus osteomyelitis and postoperative mediastinitis: a comparison of two electrocautery techniques on presternal soft tissues. J THORAC CARDIOVASC SURG 1991;101:1109.[Medline]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ronald C. Hill David R. Jones Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hill, R. C. Articles by Jones, D. R. Search for Related Content PubMed Articles by Hill, R. C. Articles by Jones, D. R.