Controlling bleeding during cardiac surgery especially at the sternotomy site is essential to prevent complications such as infection, wound dehiscence, and excessive blood transfusions. For more than a century, bone wax has been widely used to seal bleeding bone edges. However, its non-absorbable nature often contributes to delayed bone healing, foreign body reactions, and an increased risk of postoperative infections [1,2].

Today, modern surgical practice is evolving and so are the tools. Increasingly, cardiac and thoracic surgeons are replacing bone wax with gelatin sponge powder putty, a biodegradable, versatile, and clinically proven haemostatic agent that provides precise control, promotes bone healing, and significantly reduces postoperative complications.

One such advanced solution is SURGISPON^® Putty, a next-generation gelatin sponge powder putty specifically designed to overcome the limitations of traditional bone wax.

What Is SURGISPON® Putty?

SURGISPON^® Putty is made from highly purified pharmaceutical-grade gelatin and can be used dry or mixed with sterile saline or thrombin to form a putty, paste, or mousse, depending on surgical need.

Its versatile nature makes it ideal for:

• Irregular bone structures
• Deep fissures and cavities
• Sternal edges in sternotomy
• Cranial, spinal, and orthopaedic procedures

 Characteristics of SURGISPON^® Putty

These properties make SURGISPON^® Putty ideal not only for cardiac surgeries but also for cranial, spinal, and orthopaedic procedures [3].

Key Benefits at a Glance

How to Prepare and Apply SURGISPON^® Putty

SURGISPON^® Putty allows surgeons to customize the viscosity for maximum control. Here’s how to prepare and use it effectively:

Step 1 – Open the envelope of SURGISPON^®container powder

Step 2 – Add 3–4 mL/g sterile saline or thrombin for a putty, 4–5 mL/g for a paste, or 6–7 mL/g for a mousse. Stir until desired consistency is achieved

Step 3 – Compress the mixture with gloved finger into the bottom of the container/beaker (to avoid dispersion of the powder)

Step 4 -Smear or press the doughy paste against the bleeding surface

Step 5 – Remove the excess paste once haemostasis is achieved

Clinical Evidence Supporting Gelatin Sponge Powder Putty in Cardiac Surgery

A prospective randomized study compared absorbable gelatin powder(Spongostan^®) with traditional bone wax in 557 patients undergoing cardiac surgery. The putty was applied after sternotomy and before chest closure.

Key Results:

• Total blood loss:Gelatin group: 415 mL vs. Bone wax group: 580 mL

• Chest reopening for bleeding: 4.7% (gelatin) vs. 7.3% (bone wax)
• Superficial infections: 0.7% (gelatin) vs. 1.1% (bone wax)
• No deep sternal infections in either group

These results strongly support the adoption of absorbable gelatin powder for safer, more effective haemostasis in cardiac surgery [4].

Fig. 1. Gelatin preparation (1–2 g of the soluble powder is diluted in 2–3 mlof saline, then 1 cc of rifamycin is added to the semisolid compound) can bemixed and spread by a simple digital pressure on the sternal section surfaces,just after sternotomy and at the end of operation, before chest close-up [4].

Conclusion:

As the demand for surgical precision, infection control, and faster healing continues to grow, gelatin sponge powder putty is becoming the preferred choice over outdated bone wax. Products like SURGISPON^®putty offer biocompatibility, moldability, and full absorptionwithout compromising performance.

Whether you’re performing a sternotomy, a cranial discectomy, or a spinal procedure, SURGISPON^® Putty delivers proven results, trusted by surgeons worldwide.

References

[1] Allison RT. Foreign body reactions and an associated histological artefact due to bone wax. British journal of biomedical science. 1994 Mar 1;51(1):14-7.

[2] Bhatti F, Dunning J. Does liberal use of bone wax increase the risk of mediastinitis? Interactive cardiovascular and thoracic surgery. 2003 Dec 1;2(4):410-2.

[3] Riegels-Nielsen P, Greiff J, Lovgreen Nielsen P. Spongostan used forspace obliteration in bone defects. Acta Orthop Belg 1986 Jan–Feb;52:46–53.

[4] Ragusa R, Faggian G, Rungatscher A, Cugola D, Marcon A, Mazzucco A. Use of gelatin powder added to rifamycin versus bone wax in sternal wound hemostasis after cardiac surgery. Interactive cardiovascular and thoracic surgery. 2007 Feb 1;6(1):52-5.