PRACTICAL DERMATOLOGY Bone Wax in Dermatologic Surgery

Bone wax is an inert, malleable material used as a hemostatic agent in treating surgical defects. Healing by secondary intention is an appropriate approach for certain situations in dermatologic surgery. When surgical wounds are deep enough for such tissues as bone or cartilage to be exposed, dressings may adhere to granulation tissue, making removal and subsequent wound care difficult and painful. In such cases bone wax can be molded around deep tissues to create an ideal occlusive, hemostatic microenvironment that facilitates second-intention wound healing. In dermatologic surgery wound healing by second intention is an alternative to surgical reconstruction by direct closure , grafts, or flaps. Although with this approach the wound requires more time to heal, it has the oncologic advantage of not involving the displacement of adjacent tissue planes, ଝ Please cite this article as: Alegre M, et al. Cera para huesos en la cirugía dermatológica. which can conceal possible deep tumor foci. If the surgical wound is allowed to close completely by second intention, however, there may be complications such as bleeding, pain, and, especially, the contraction and retraction of the wound that can lead to an unsightly scar. The second-intention healing of any surgical wound consists of 4 phases. 1 The first phase starts immediately after the surgical incision, with the exposure of platelets that activate the coagulation cascade. A few hours after this hemostatic phase, the inflammatory phase begins, with the 1578-2190/$ – see front matter