Absorbable hemostatic composition

- Ethicon, Inc.

An absorbable hemostatic composition for use in the control of osseous hemorrhage, comprising a biocompatible fatty acid salt in a biocompatible base, said composition having a putty-like consistency at room temperature. The preferred composition is one in which the fatty acid salt is calcium stearate.

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Description
BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to a bone sealant and more particularly to an absorbable hemostatic composition, comprising a biocompatible fatty acid salt in a biocompatible base, the composition having a putty-like consistency at room temperature. This invention also relates to a process for applying the bone sealant.

2. Description of Prior Art

Various substances and compositions have been employed by members of the medical profession to control bleeding from cut bone surfaces. One class of materials used for the control of this type of hemorrhage is called bone wax. Bone waxes are used for the purpose of controlling hemorrhages from the cut surfaces of bones, such as those of the skull, by forcibly smearing the wax over the cut surface so that the material acts mechanically to occlude and seal the open ends of the bleeding osseous vessels and sinuses.

Bone waxes used in surgery today are generally prepared from refined beeswax which has been admixed with other nonabsorbable and water insoluble hydrocarbons and vegetable oils. Certain disadvantages inhere in these bone wax compositions, as for example, relatively poor adhesion properties, and the hard brittle state of the wax at room temperatures requiring use at elevated temperatures. Furthermore, paraffin based commercial bone wax is not absorbed by the body and thus remains at the site of application for long periods of time. As a result the wax acts as a foreign material, tending, in some instances, to make it difficult for the body to fight infection and inflammatory reactions that may be introduced in the surrounding tissue, and it also interferes with bone regrowth.

In order to overcome the latter problem, British Pat. No. 1,584,080 discloses an absorbable hemostatic bone sealant, which contains the active components collagen and fibrin. However, the composition of British Pat. No. 1,584,080 suffers from the disadvantage that its storage conditions must be controlled in order to retain desirable aesthetic and tactile properties since biological materials of animal origin are used.

U.S. Pat. No. 3,395,217 discloses nonabsorbable bone wax compositions comprised of low molecular weight ethylene copolymer waxes containing from about 15 to about 40 percent by weight of another unsaturated constituent and having molecular weights in the range of 1000 to 4000. These waxes have a semisolid consistency such that they can be kneaded between the fingers when at room temperature and have the right amount of tack and adhesion so that they can be easily manipulated in the hands of the surgeon or applied by any suitable applicator such as a gloved finger, spatula or appropriate disposable applicator.

U.S. Pat. No. 2,722,999 describes an absorbable bone wax comprised of a water soluble innocuous base and free acid cellulose glycolic acid ether or free acid cellulose hydroxypropionic acid ether as a hemostatic agent. The composition also preferably contains a tackifier such as cellulose glycolic acid ether salt or cellulose hydroxypropionic acid ether salt (preferably sodium salt) and water as a plasticizer. It is to be noted that cellulose and its derivatives are generally not biologically degradable, but merely soluble, and if the molecular weights are high enough, may not even pass through the kidneys.

The Annals of Surgery 132, 1128 (1950) describes an absorbable hemostatic bone wax containing powdered oxidized cellulose as the hemostatic agent in a base of polyethylene glycol. The base is a mixture of high and low molecular weight polyethylene glycols selected to provide the malleability and consistency of material desired for this application. However, polyethylene glycols are completely water soluble. When they comprise the largest percentage of the mixture, the mixture becomes slimy in the area wet with tissue fluids, this being true of any water soluble base. In addition, some polyethylene glycols give a pronounced tissue reaction.

U.S. Pat. No. 4,186,448 discloses a one-piece molded body member for filling and covering a bone void or soft tissue deficiency, which body member attracts blood in fluid suspension by capillary action until clotting forms which ultimately leads to the formation of tissue and/or bone. The body member is made of a biodegradable material such as polylactic acid.

The present invention provides a new absorbable bone sealant which is a putty-like semisolid at room temperature. The softness of the sealant allows the material to be packaged in a syringe, plastic or coated paper envelope, or aluminum or glass tube from which it may be extruded or dispensed in desired amounts during use. The sealant has sufficient tack so that it adheres to bone surfaces, yet is easily manipulated in the hands of the surgeon without crumbling or sticking to the surgeon's gloves.

In accordance with expectations based on prior experience, the preferred fatty acid salt of the present invention, calcium stearate, would have been expected to remain as a separate phase after having been mixed with an oil. It has been found, surprisingly, in accordance with the present invention, that when calcium stearate is heated with castor oil (or other bicompatible bases mentioned herein), there is produced a gelatinous product having a translucent appearance with a waxy consistency, particular suitable as a bone sealant. Furthermore, the compositions of the present invention also possess the advantage of not "setting-up" even after a long period of standing and they also maintain an aesthetic physical appearance. Also, they can be sterilized by radiation without affecting their properties. Thus, the appropriate consistency, set-up, smearability and translucency (which are desirable properties in a bone-wax) are to be found in the sealant of the present invention. Furthermore, calcium stearate is known to be completely absorbable in the body (see U.S. Pat. No. 4,201,216, wherein a coating, which is about 50% calcium stearate, is applied to synthetic absorbable sutures). In addition to being absorbable, the compositions of the present invention also demonstrate a low level of tissue reaction.

SUMMARY

The bone sealant composition of the present invention comprises

(i) a component (A) comprising either a bicompatible fatty acid salt alone which comprises between 45% to 80% by weight (based on the weight of the total composition); or a mixture of said fatty acid salt with a bicompatible in vivo absorption enhancing agent in which said mixture comprises between 35% and 45% by weight of said fatty acid salt (based on the weight of the total composition) and between 25% and 35% by weight of said absorption enhancing agent (based on the weight of the total composition); and

(ii) a component (B) comprising a biocompatible base.

The cation of the fatty acid salt is selected from the group consisting of calcium, magnesium, zinc, aluminum, lithium, and barium, the fatty acid anion being saturated or unsaturated and containing from 10 to 22 carbon atoms in the chain. This composition has a putty-like consistency at room temperature, and a tackiness sufficient for it to adhere readily a bloody bone surface. This permits a surgeon to spread the sealant with his fingers or a spatula over the cut surface of a bone and at the same time the sealant will adhere to the bone surface.

The sealant has a consistency of a semisolid which is extrudable from a large orifice syringe. The sealant is packaged in a syringe, plastic envelope or aluminum tube and sterilized by high energy radiation. During use, small amounts of the sealant may be extruded from the package as required by the surgeon. The sealant is effective to control osseous hemorrhage from cut bone and does not interfere with subsequent healing and rejoining of bone parts.

DESCRIPTION OF PREFERRED EMBODIMENTS

The composition of the present invention consists preferably of calcium stearate in a biocompatible base, a preferred base being castor oil. The composition optionally includes an agent for enhancing in vivo absorption, a preferred agent in this connection being dextran. Other suitable biocompatible bases are triglycerides that are known to be metabolizable (as well as fatty acid esters such as isopropyl palmitate known as Deltyl Prime), which glycerides or esters impart desirable organoleptic characteristics and which are nontoxic and nonirritating. In this connection, suitable triglycerides are: sesame oil, almond oil, castor oil, cottonseed oil, corn oil, olive oil, cod liver oil, safflower oil, and soya oil. Other suitable bases are ethylene oxide/propylene oxide block copolymers (known by the trademark Pluronic), polyethylene glycols and methoxy polyethylene glycols (known by the trademark Carbowax). In general, although the above discussed bases are preferred, any biocompatible base which consists of a natural or synthetic oil or wax may be used provided that the composition of fatty acid salt plus base has a putty-like consistency at room temperature and also has a tackiness sufficient for it to adhere readily to a bloody bone surface. When component (A) consists of a fatty acid salt alone, up to 40% by weight of water (based upon the total weight of the composition) may also be added if desired. In such event, the oil or wax base should be present in a weight percent of at least 15% (based on the weight of the total composition).

When component (A) consists of a fatty acid salt plus an absorption enhancing agent, up to 10% by weight of water (based on the weight of the total composition), may be added. In such event, at least 20 weight % of the oil or wax base should be present (based on the weight of the total composition).

The preferred component (A) is calcium stearate. However, fatty acid anions other than the stearate anion may be used. These anions may be saturated or unsaturated and may contain from 10 to 22 carbon atoms in the chain. An example of a suitable unsaturated fatty acid anion is that derived from oleic acid. It should be noted that unnatural fatty acid anions such as the undecylenate are also suitable. Commercial calcium stearate which is suitable for use in the present invention contains up to 33% of calcium palmitate. It should further be noted, that the myristate (which contains 14 carbon atoms in the chain) is also suitable for use in the present invention.

One desirable composition of the present invention consists of calcium stearate in a castor oil base, in which the calcium stearate comprises between 55% and 70% by weight of the composition (a preferred composition containing approximately 60% by weight of calcium stearate). The most preferred in vivo absorption enhancing agent is dextran; and a preferred composition in this connection comprises between 35% and 45% by weight of calcium stearate (based on the weight of the total composition); between 25% and 35% by weight of dextran (based on the weight of the total composition), the remainder being castor oil. A preferred composition comprises about 41 weight % calcium stearate, about 30 weight % dextran and about 29 weight % castor oil.

It is also desirable to add water to the above three ingredients. This reduces the slight granular handling quality of dextran when a thin film of the composition containing same is rubbed between bare fingers. The resultant composition comprises about 38 weight % calcium stearate, about 28 weight % dextran, about 27 weight % castor oil and about 7 weight % water.

Other desirable hemostatic compositions of the present invention, comprise from 45% to 80% by weight of calcium stearate, and a biocompatible base consisting of isopropyl palmitate, sesame oil, almond oil, castor oil, ethylene oxide/propylene oxide block copolymers, polyethylene glycols or methoxy polyethylene glycols.

Applicant has found that compositions of the invention containing a castor oil base, exhibit good adherence to bone, being better in this regard than other compositions of the invention utilizing certain of the other bases.

In order to homogenize the present compositions, a solution of the components, involving little or no chemical change is desirable. The first method of doing so would be to stir a molten liquid of the components. Overall this method is relatively unsuccessful, since the oily emulsion, present during heating, tends to be followed by a phase separation.

A second, more successful method, consists of mechanical mixing by means of mortar and pestle. By means of this method of mechanical mixing, the proper consistency, set-up and smearability are attained. When preparing the mixture, it is preferred to utilize calcium stearate having a particle size of under 100 microns, but more preferably between 10 and 20 microns. Applicant has found that the compounding process is aided by heating the emollient (preferably for about 30 minutes in a 70.degree. C. oven) prior to mixing and then heating the mixture (overnight in a 70.degree. C. oven). On an industrial scale the mixing process may be carried out using a dough mixer or some means of applied pressure (i.e. piston action). A three roll mill of the type used to disperse pigments in protective coatings would be ideal. The customary steel rolls should be replaced with porcelain or other ceramic materials.

Mixtures Gelatinized by Heating

An emollient may be incorporated in the instance wherein the latter gelatinizes with calcium stearate upon heating. The effect is probably due to partial dissolution of the stearate and establishment of a dissolved/undissolved equilibrium both of solid in liquid and liquid in solid as well. Isopropyl palmitate forms such a gel and a typical composition is prepared by mixing about 35 parts of isopropyl palmitate with about 65 parts of an edible grade of calcium stearate. This is heated to about 150.degree. C. while stirring with a spatula for about 15 to 20 minutes. A transition from opaque white to opalescent/translucent occurs after heating and is maintained in the cooled (room temperature) mixture. Upon cooling, a somewhat "set-up" consistency is formed which very quickly gives way to a desirable workability by hand. When cooled, the surface acquires a very shiny glaze, somewhat suggestive of a true solution at the surface. No oily separation occurs upon standing. In certain instances, upon standing at room temperature overnight, the translucency of the above calcium stearate /isopropyl palmitate gel, reverts back to opacity. Reheating to 150.degree. C. restores the translucency. Occasionally, a mixture will result in a continual return to opacity even after repeated heating. However, a number of gels prepared by Applicant and stored in beakers for over a year still retained their original translucent appearance. When it was attempted to prepare gelatinized mixtures of calcium stearate with either sesame or almond oil, they did not gelatinize as readily or as smoothly as did the mixtures of calcium stearate and isopropyl palmitate. It will thus be seen that different methods of mixing the compounds ought to be selected, according to the nature of the components.

Applicant has found that when calcium stearate is mixed with isopropyl palmitate (preferably in a ratio of 64:36 by weight) using mortar and pestle, this results in a putty-like mass having the consistency desirable in a bone wax. The color, however, is opaque white rather than opalescent/translucent which would be encountered in the instance wherein gelatinization by heat is possible.

Using the mortar and pestle method, however, allows viable mixtures to be prepared from many more candidates than is possible by heating alone. Thus, mixtures whose handworkability properties are quite desirable, may be prepared by mortar and pestling calcium stearate (roughly in the ratio of 64:36 by weight) with either sesame oil, castor oil, Carbowax 400 or Pluronics F68 and water. A dough mixer or a 2 or 3 roll mill (as used in grinding paint or rubber and vinyl compositions) would be ideal for preparing such mixtures. In the latter instance, heat as well as grinding could be applied. Wherever heating shows evidence of creating an equilibrium between dissolved/undissolved phases (as in the gelatinized compositions), this may contribute towards greater stability and less separation of phases by reducing the fugitivity of the oily component.

In Vivo Absorption

Preliminary tests in animals have demonstrated minimal tissue reaction with a mixture such as calcium stearate and sesame oil or castor oil. (See Table 4) Using radio isotopes, it has been found that calcium stearate, in vivo, on its own, is 85% absorbed after fourteen days. However, when calcium stearate is mixed with a second component which is also hydrophobic, such as a triglyceride oil, the hydrophobic barrier which is established and presented to the surrounding tissues may extend the absorption time beyond ninety days, in spite of the fact that both components are absorbable individually. The hydrophobicity may be reduced by incorporating a small percent of a hydrophile which acts as an in vivo absorption enhancing agent (for example, Carbowax, Pluronics, glycerine or propylene glycol). When dextran is incorporated as the third and hydrophilic component, it reduces the hydrophobic barrier and encourages the infiltration of host tissue cells, thus contributing towards faster absorption. Alternatively, the porosity may be maintained by using a small percentage of the total calcium stearate in a coarser form. In this connection, the porosity (due to the particulate nature of calcium stearate) normally would be considered to help invading cells to obtain a foothold and thus be instrumental in absorption). Such porosity may also be maintained by incorporating a small percentage of an absorbable polymer such as a fiber or a grit (for example, catgut powder) or an absorbable inorganic material such as calcium sulfate, into the calcium stearate/oil mixture.

Table 1 sets forth consistency and tactile properties of the instant compositions. It will be noted from Table 1 that the calcium stearate-sesame oil composition and the calcium stearate-almond oil composition provide the most desirable properties of those compositions listed in the Table. Applicant has also found that sterilization with high energy radiation from a Cobalt-60 source, generally has no adverse effect on the consistency and tactile properties of most of the compositions of Table 1. Nevertheless, the effect of sterilization with Cobalt-60 on the compositions of the present invention, is shown in Table 2.

In Vivo Studies

Tissue reaction and efficiacy studies were carried out as summarized in the following Tables 3, 4 and 5. The tests were carried out in rats to determine the tissue reaction evoked by the various materials. Three rats were used per sample and the material was either implanted or injected into the ventral subcutis. If the material was solid, approximately 1 cm by 1 cm squares were implanted; if the material was in the form of granules or powder, two scoopfuls, using a small flat spatula were placed in a subcutaneous pocket; and if the materials were liquid, 0.25 mls of the liquid were injected into the subcutis. The rats were examined after 24 hours and usually one rat was killed at this time. The remaining rats were observed for seven days, whereafter they were killed. The implant sites were then exposed and characterized. These characterizations are set forth in Tables 3, 4 and 5.

As will be noted from Table 3, after seven days, essentially none of the single components gave evidence of irritation. However, this is not true of the observations at 24 huours, which vary more widely. As will be noted from Table 4, the two compositions based upon Deltyl Prime or sesame oil, exhibited no adverse tissue reaction, while the remaining two had unfavorable reactions. It should be noted, however, that Carbowax 400 was reported as having no adverse tissue reaction when injected individually; however, as a component of bone wax the reaction was pronounced.

Studies concerning intramuscular absorption of certain bone sealant implants are summarized in Table 6. The formulation of 60% calcium stearate and 40% castor oil by weight showed superior wet handling properties. However, in such formulation, the castor oil retarded absorption and break-up of the calcium stearate implant because of its water repellent nature. It is to be noted that twelve weeks passed before the implant was gone. The formulation which contained 41.4% calcium stearate, 30% dextran and 28.6% castor oil by weight, demonstrated relatively fast absorption. Thus, substantial cell ingrowth into the implant was evident after one week in vivo, implant breakup due to cell ingrowth occurred after two weeks in vivo, and after four weeks in vivo only small areas of tissue reaction were evident in the implants. The four week implants only showed areas of inflammatory cells with a few circular areas present which were most probably fat cells.

Also included within the scope of the present invention is the process for the control of bleeding from cut bone surfaces, which comprises applying to the cut bone surface, the hemostatic composition comprising

(i) a component (A) comprising either a biocompatible fatty acid salt alone which comprises between 45% and 80% by weight (based on the weight of the total composition); or a mixture of said fatty acid salt with a biocompatible in vivo absorption enhancing agent in which said mixture comprises between 35% and 45% by weight of said fatty acid salt (based on the weight of the total composition) and between 25% and 35% by weight of said absorption enhancing agent (based on the weight of the total composition); and

(ii) a component (B) comprising a biocompatible base.

The cation of said fatty acid salt is selected from the group consisting of calcium, magnesium, zinc, aluminum, lithium and barium, the fatty acid anion being saturated or unsaturated and containing from 10 to 22 carbon atoms in the chain, said composition having a putty-like consistency at room temperature, and tackiness sufficient for it to adhere readily to a bloody bone surface.

The present process is preferably carried out utilizing a composition in which the base is selected from the group consisting of isopropyl palmitate, sesame oil, almond oil, castor oil, ethylene oxide/propylene oxide block copolymers, polyethylene glycols and methoxypolyethylene glycols.

The present process is most preferably carried out utilizing a composition in which component (A) is calcium stearate plus dextran and the base is castor oil. Up to 10% by weight of water (based on the weight of the total composition) may be added, provided at least 20% by weight of castor oil is present (based on the weight of the total composition).

A preferred composition used in this process is one in which the proportions are about 41% by weight calcium stearate, about 30% by weight dextran and about 29% by weight castor oil.

When water is added, a desirable composition used in this process, comprises about 38 weight % calcium stearate, about 28 weight % dextran, about 27 weight % castor oil and about 7 weight % water.

The following examples are provided to further illustrate embodiments of the present invention.

EXAMPLE 1 Mixture of Calcium Stearate and Isopropyl Palmitate Gelatinized by Heating

Thirty-five parts by weight of isopropyl palmitate is mixed with 65 parts by weight of an edible grade of calcium stearate (free of the chick edema factor). The mixture is then heated to about 150.degree. C. while stirring with a spatula for about 15 to 20 minutes. A transition from opaque white to opalescent/translucent occurs after heating and is maintained in the cooled (room temperature) mixture. Upon cooling, a somewhat "set-up" consistency is formed which very quickly gives way to a desirable workability by hand. When cooled, the surface acquires a very shiny glaze. No oily separation occurs upon standing.

EXAMPLE 2 Mixture of Calcium Stearate and Isopropyl Palmitate by Mortar and Pestling

Sixty-four parts by weight of an edible grade of calcium stearate is mixed with 36 parts by weight of isopropyl palmitate and the mixture is then mortared and pestled for about 15 minutes. This results in a desirable putty-like mass having the consistency desirable in a bone wax. The color, however, is opaque white, rather than opalescent/translucent, such as that prepared in accordance with the process of Example 1.

                                    TABLE 1                                 

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     ABSORBABLE BONE WAX                                                       

     Consistency & Tactile Properties of Calcium Stearate Based Compositions*  

               Composition, % Wt.                                              

                                                 Calc. Stear. 48               

               Calc. Stear. **64                                               

                       Calc. Stear. 65                                         

                               Calc. Stear. 63                                 

                                       Calc. Stear. 64.25                      

                                                 Pluronic F68 20               

               Deltyl Prime 36                                                 

                       Almond Oil 35                                           

                               Sesame Oil 37                                   

                                       Carbowax 400 45.75                      

                                                 H.sub.2 O 32                  

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     Means of Mixing           Mortar and Pestle                               

     Consistency                                                               

               smooth soft                                                     

                       smooth  smooth  smooth    smooth, soft                  

               spongy, less                                                    

                       soft    soft    soft      sticky, spongy                

               sticky than             dough-like                              

                                                 airy                          

               Pluronic                                                        

     Appearance                                                                

               white, opaque                                                   

                       off-white                                               

                               off-white                                       

                                       white, opaque                           

                                                 white, opaque                 

                       semi-trans-                                             

                               semi-trans-                                     

                       lucent  lucent                                          

     Greasiness                                                                

               v. slightly                                                     

                       waxy    waxy    slightly oily                           

                                                 N.A. dries on hand            

                                                 when smeared thin             

     Smearability                                                              

               v. good v. good v. good v. good   N.A. dries on hand            

                                                 when smeared thin             

     Odor      none    none    none    slight    none                          

     Relative Rating***                                                        

               4       1       1       3         2                             

     based on physical v. similar                                              

     properties                                                                

     Viscosity 1911            2372    3427      Begin 225, 369                

     Shear Rate 228.5                            End 179, 241                  

     Temp. 35.degree. C.                         Temp. Rise to 36.degree. C.   

     Laptron Rheometer                                                         

     __________________________________________________________________________

      *Observations before sterilization.                                      

      **Calcium Stearate used was a very fine particle size lot.               

      ***Subjective Scale: 1-5, 1best & 5worst.                                

                                    TABLE 2                                 

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     ABSORBABLE BONE WAX                                                       

     Effects of Cobalt Sterilization on Consistency & Tactile Properties*      

                  Signs of Separation                                          

                  Change in                                                    

                         Change in                                             

                                 Oily    Phase        Change                   

                                                            Change in          

              Wt %                                                             

                  Consistency                                                  

                         set-up  Surface Separation                            

                                               Smeariness                      

                                                      Color Odor               

     __________________________________________________________________________

     Calcium Stearate                                                          

              64  none   none    none    none  same   none  slight             

     Deltyl Prime                                                              

              36                                            enhancement        

                                                            of odor            

     Calcium Stearate                                                          

              63  none   none    none    none  same   none  none               

     Sesame   37                                                               

     Calcium Stearate                                                          

              54.25                                                            

                  none   none    generated                                     

                                         none  same   none  none               

     Carbowax 400                                                              

              45.75              on prolonged                                  

                                 exposure to                                   

                                 air                                           

     Calcium Stearate                                                          

              48  none   stiffens on                                           

                                 none    none  same   none  none               

     Pluronic F68                                                              

              20         prolonged                                             

     Water    32         exposure to                                           

                         air, set-up                                           

                         & consistency                                         

                         regenerated                                           

                         with work up                                          

     __________________________________________________________________________

      *Effect of Cobalt60 determined by comparing packaged & sterilized samples

      to similar samples left unsterilized                                     

                                    TABLE 3                                 

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     ABSORBABLE BONE WAX                                                       

     Results of Tissue Reaction to Individual Sterile Components               

                          Sterilization                                        

                                 Results (ventral subcutis) Rats               

     Component                                                                 

             Package                                                           

                    Air or N.sub.2                                             

                          .sup.60 Co,mR                                        

                                 1 Day         7 Days                          

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     Deltyl Prime                                                              

             vial   N.sub.2                                                    

                          2.5    No adverse Tissue Reaction                    

                                               NATR, small amount              

                                 (NATR) slight congestion &                    

                                               of injected fluid               

                                 edema at periphery of                         

                                               remained.                       

                                 encapsulated fluid.                           

     Sesame Oil                                                                

             vial   N.sub.2                                                    

                          2.5                  Transparent jelly-              

                                               like mass on skin               

                                               side containing                 

                                               clear oil fluid.                

     Carbowax 400                                                              

             vial   N.sub.2                                                    

                          2.5    No adverse Rxn in live rat.                   

                                               NATR, no evidence               

                                               of injected material.           

     Pluronic F68                                                              

             P.E. sleeve-                                                      

                    Air   2.5    Extensive edema, Systemic                     

                                               NATR, Rats                      

     +4-5% H.sub.2 O                                                           

             then foil           Effects: lethargic, anal                      

                                               appeared in good                

             pouch               area wet, paws tinged with                    

                                               health, material                

                                 blood.        completely absorbed.            

     Almond Oil                                                                

             vial   N.sub.2                                                    

                          2.5                  NATR                            

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                                    TABLE 4                                 

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     ABSORBABLE BONE WAX                                                       

     Results of Tissue Reaction to Implanted Bone Wax Compositions             

     Composition                                                               

              Wt. %                                                            

                  Results After 7 Day Implantation (Ventral Subcutis)          

     __________________________________________________________________________

                  Rats                                                         

     Calcium Stearate                                                          

              64  No adverse tissue reaction, small amount of hemmorrhaging.   

     Deltyl Prime                                                              

              36  No change in consistency or color of bone wax. Thinly        

                  encapsulated with small amount of fluid in one rat.          

     Calcium Stearate                                                          

              63  No adverse tissue reaction.                                  

     Sesame Oil                                                                

              37                                                               

     Calcium Stearate                                                          

              54.25                                                            

                  Bone wax encapsulated w/bloody fluid. Bone wax not           

     Carbowax 400                                                              

              45.75                                                            

                  intact, bone wax not loose, most stuck to the sides          

                  of the capsule.                                              

     Calcium Stearate                                                          

              48  White, creamy, thick capsule. Bonewax dispersed as           

     Pluronic F68                                                              

              20  spongy mass stuck to the sides of capsule.                   

     H.sub.2 O                                                                 

              32                                                               

     __________________________________________________________________________

      Twenty 1 gram samples of each of the 4 candidates were packaged and      

      sterilized for toxicity studies. The packaging involved placing bone wax 

      pellet in polyethylene sleeve (sealed on 3 sides), then inserting the    

      sleeve to a foil pouch and scaling under  nitrogen. Fifteen packages     

      received 2.5 Mrads of .sup.60 Co sterilization while the remaining 5 were

      kept as a control. All implanted samples were sterile.                   

                                    TABLE 5                                 

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     ABSORBABLE BONE WAX                                                       

     Select Candidates, Summary of Aesthetic, Tissue Reaction & Surgical Use   

     Properties                                                                

                  Consis-                                                      

     Composition                                                               

              Wt. %                                                            

                  tency*                                                       

                      Tissue Reaction to Rats (See Table 5 for                 

     __________________________________________________________________________

                      Details)                                                 

     Calcium Stearate                                                          

              64  3   NATR, (no adverse tissue reaction) no change in          

     Deltyl Prime                                                              

              36      consistency or color of bone wax.                        

     Calcium Stearate                                                          

              63  5   NATR, No change in consistency or color of bone wax.     

     Sesame Oil                                                                

              37                                                               

     Calcium Stearate                                                          

              54.25                                                            

                  4   Bone wax encapsulated with bloody fluid, bone            

     Carbowax 400                                                              

              45.75   wax not intact.                                          

     Calcium Stearate                                                          

              48  4   White, creamy thick capsule. Bone wax dispersed          

     Pluronic F68                                                              

              20      as spongy mass stuck to side of capsule. Not a           

     H.sub.2 O                                                                 

              32      favorable reaction.                                      

     __________________________________________________________________________

      *All samples packaged and sterilized, see Table 4.                       

      Scale 1-5, 5 best, 1 worst.                                              

                                    TABLE 6                                 

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     INTRAMUSCULAR* ABSORPTION OF BONE SEALANT IMPLANTS                        

     (Effect of absorption enhancing agent)                                    

                             Calcium Stearate 41.4%                            

               Calcium Stearate 60.0%                                          

                             Dextran 30.0%                                     

     Absorption Time                                                           

               Castor Oil 40.0%                                                

                             Castor Oil 28.6                                   

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     One Week  no cell ingrowth                                                

                             little tissue reaction                            

               little tissue reaction                                          

                             most of implant in one piece                      

     Two Weeks implant smaller, intact                                         

                             implant breaking up                               

               inflammatory cell area                                          

                             substantial cell growth                           

               larger                                                          

     Four Weeks                                                                

               implant smaller, intact                                         

                             implant gone                                      

               very small area of                                              

                             small area of inflammatory cells                  

               inflammatory cells around                                       

                             and fat cells remaining                           

               implant                                                         

     Eight Weeks                                                               

               implant smaller, intact                                         

               surrounded by inflammatory                                      

               cells                                                           

     Twelve Weeks                                                              

               implant gone                                                    

               area of inflammatory cells                                      

               left                                                            

     Handling Qualities                                                        

               good          good; does not become soft                        

                             or sticky when wet                                

                             can feel slight granular                          

                             nature of Dextran when a                          

                             thin film is rubbed                               

                             between bare fingers                              

     __________________________________________________________________________

      *Cylindrical rods of bone scalant (which had received .sup.60 Co         

      sterilization). Approximately 1 mm. diameter, were implanted             

      intramunicularly in rats via a 16 gauge syringe needle.                  

Having now described the invention in detail, it should be readily apparent to one skilled in the art that there are various modifications and alterations which may be made without departing from the spirit and scope of the present invention.

Claims

1. An absorbable hemostatic composition for use in the control of osseous hemorrhage, comprising:

(i) a component (A) comprising either a biocompatible fatty acid salt alone, which comprises between 45% and 80% by weight based on the weight of the total composition; or a mixture of said fatty acid salt with a biocompatible in vivo absorption enhancing agent, in which said mixture comprises between 35% and 45% by weight of said fatty acid salt based on the weight of the total composition, and between 25% and 35% by weight of said absorption enhancing agent, based on the weight of the total composition; and.Iadd.the remainder of the composition comprising.Iaddend.
(ii) a component (B) comprising a body absorbable biocompatible base selected from the group consisting of ethylene oxide.[.proplylene.]..Iadd.propylene.Iaddend.oxide block copolymers, polyethylene glycols and methoxypolyethylene glycols, triglycerides and fatty acid esters,

2. The composition of claim 1, in which component (A) comprises calcium stearate, calcium palmitate or calcium myristate.

3. The composition of claim 1, in which component (B) is selected from the group consisting of sesame oil, almond oil, castor oil, cottonseed oil, corn oil, olive oil, cod liver oil, safflower oil and soya oil.

4. The composition of claim 1, in which the absorption enhancing agent is selected from the group consisting of dextran, Carbowax, Pluronics, glycerine and propylene glycol.

5. An absorbable hemostatic composition for use in the control of osseous hemorrhage, comprising:

(i) a component (A) consisting of a biocompatible fatty acid salt,
(ii) at least 15% by weight of a component (B) comprising a body absorbable biocompatible base selected from the group consisting of ethylene oxide/propylene oxide block copolymers, polyethylene glycols and methoxypolyethylene glycols, triglycerides and fatty acid esters,

6. An absorbable hemostatic composition for use in the control of osseous hemorrhage, comprising:

(i) a component (A) comprising a mixture of a biocompatible fatty acid salt with a biocompatible in vivo absorption enhancing agent, in which said mixture comprises between 35% and 45% by weight of said fatty acid salt, based on the weight of the total composition, and between 25% and 35% by weight of said absorption enhancing agent, based on the weight of the total composition;
(ii) at least 20% by weight of a component (B) comprising a body absorbable biocompatible base, selected from the group consisting of ethylene oxide/propylene oxide block copolymers, polyethylene glycols and methoxypolyethylene glycols, triglycerides and fatty acid esters,

7. The composition of claim 6, comprising about 38 weight % calcium stearate, about 28 weight % dextran, about 27 weight % castor oil and about 7 weight % water.

8. An absorbable hemostatic composition for use in the control of osseous hemorrhage, comprising:

(i) a component (A) comprising a mixture of calcium stearate and dextran in which said mixture comprises between 35% and 45% by weight of said calcium stearate based on the weight of the total composition, and between 25% and 35% by weight of dextran, based on the weight of the total composition; and.Iadd.the remainder of the composition comprising.Iaddend.
(ii) a component (B) comprising a biocompatible base consisting of a natural or synthetic oil or wax which is soluble in the body,

9. The composition of claim 8, in which component (B) is selected from the group consisting of sesame oil, almond oil, castor oil, cottonseed oil, olive oil, cod liver oil, safflower oil and soya oil.

10. An absorbable hemostatic composition for use in the control of osseous hemorrhage, comprising:

(i) a component (A) comprising a mixture of biocompatible fatty acid salt with a biocompatible in vivo absorption enhancing agent, in which said mixture comprises between 35% and 45% by weight of said fatty acid salt based on the weight of the total composition and between 25% and 35% by weight of said absorption enhancing agent based on the weight of the total composition; and the.Iadd.remainder of the composition comprising.Iaddend.
(ii) a component (B) comprising a biocompatible base, consisting of a natural or synthetic oil or wax which is absorbable in the body, the cation of said fatty acid salt being selected from the group consisting of calcium, magnesium, zinc, aluminum, lithium and barium, the fatty acid anion being saturated or unsaturated and containing from 10 to 22 carbon atoms in the chain; said composition having a putty-like consistency at room temperature, and a tackiness sufficient for it to adhere readily to a bloody bone surface.

11. The composition of claim 10, in which the absorption enhancing agent is selected from the group consisting of dextran, Carbowax, Pluronics, glycerine and propylene glycol.

12. An absorbable hemostatic composition for use in the control of osseous hemorrhage, comprising:

(i) a component (A) consisting of a biocompatible fatty acid salt which comprises between 45% and 80% by weight based on the weight of the total composition; and.Iadd.the remainder of the composition comprising.Iaddend.
(ii) a component (B) comprising a biocompatible base, consisting of a natural or synthetic oil or wax which is absorbable in the body, the cation of said fatty acid salt being selected from the group consisting of calcium, magnesium, zinc, aluminum, lithium and barium, the fatty acid anion being saturated or unsaturated and containing from 10 to 22 carbon atoms in the chain; said composition having a putty-like consistency at room temperature, and a tackiness sufficient for it to adhere readily to a bloody bone surface.

13. An absorbable hemostatic composition for use in the control of osseous hemorrhage, comprising between 35% and 45% by weight of calcium stearate, between 25% and 35% by weight of dextran, the remainder comprising castor oil.

14. The composition of claim 13, comprising about 41 weight percent calcium stearate, about 30 weight percent dextran and about 29 weight percent castor oil.

15. An absorbable hemostatic composition for use in the control of osseous hemorrhage, comprising from 45% to 80% by weight of calcium stearate, and.Iadd.the remainder of the composition comprising.Iaddend.a body absorbable biocompatible base selected from the group consisting of isopropyl palmitate, sesame oil, almond oil, castor oil, ethylene oxide/propylene oxide block copolymers, polyethylene glycols and methoxypolyethylene glycols.

16. The composition of claim 15, in which the calcium stearate comprises between 55% and 70% by weight of the composition.

17. The composition of claim 16, in which the calcium stearate comprises between about 59% and 61% by weight of the composition, and the base is castor oil.

18. A process for the control of bleeding from cut bone surfaces, which comprises applying to the cut bone surface a hemostatic composition comprising

(i) a component (A) comprising either a biocompatible fatty acid salt alone which comprises between 45% to 80% by weight, based on the weight of the total composition; or a mixture of said fatty acid salt with a biocompatible in vivo absorption enhancing agent in which said mixture comprises between 35% and 45% by weight of said fatty acid salt based on the weight of the total composition, and between 25% and 35% by weight of said absorption enhancing agent based on the weight of the total composition; and.Iadd.the remainder of the composition comprising.Iaddend.
(ii) a component (B) comprising a body absorbable biocompatible base, selected from the group consisting of ethylene oxide/propylene oxide block copolymers, polyethylene glycols and methoxypolyethylene glycols, triglycerides and fatty acid esters, the cation of said fatty acid salt being selected from the group consisting of calcium magnesium zinc, aluminum, lithium and barium, the fatty acid anion being saturated or unsaturated and containing from 10 to 22 carbon atoms in the chain; said composition having a putty-like consistency at room temperature, and a tackiness sufficient for it to adhere readily to a bloody bone surface.

19. The process of claim 18, in which component (B) is selected from the group consisting of isopropyl palmitate, sesame oil, almond oil, castor oil, ethylene oxide/propylene oxide block copolymers, polyethylene glycols and methoxypolyethylene glycols.

20. A process for the control of bleeding from cut bone surfaces, which comprises applying to the cut bone surface a hemostatic composition comprising:

(i) a component (A) comprising a mixture of calcium stearate and dextran in which said mixture comprises between 35% and 45% by weight of said calcium stearate based on the weight of the total composition and between 25% and 35% by weight of dextran based on the weight of the total composition; and.Iadd.the remainder of the composition comprising.Iaddend.
(ii) a component (B) comprising a biocompatible base selected from the group consisting of ethylene oxide/propylene oxide block copolymers, polyethylene glycols and methoxypoly-ethylene glycols, triglycerides and fatty acid esters,

21. The process of claim 20, in which component (B) is castor oil.

22. The process of claim 20, in which the composition includes up to 10 weight % of water based on the weight of the total composition, there being present at least 20 weight % of castor oil based on the weight of the total composition.

Referenced Cited
U.S. Patent Documents
2772999 December 1956 Masci et al.
3395217 July 1968 Statt
4186448 February 5, 1980 Brekke
4201216 May 6, 1980 Mattei
Foreign Patent Documents
1584080 February 1981 GBX
Other references
  • Annals of Surgery, vol. 132, 1950, pp. 1128-1130, New Absorbable Hemostatic Bone Wax, Drs. Geary and Frantz. Chemical Abstracts 82:46252e (1975). Chemical Abstracts 85:161435r (1976).
Patent History
Patent number: RE32208
Type: Grant
Filed: Oct 29, 1984
Date of Patent: Jul 15, 1986
Assignee: Ethicon, Inc. (Somerville, NJ)
Inventors: Frank V. Mattei (Piscataway, NJ), Martin Stephenson (Peterborough), Allin K. Gordon (Peterborough), Namassivaya Doddi (Upland, CA)
Primary Examiner: Leonard Schenkman
Attorney: Leonard Kean
Application Number: 6/665,552