April 30, 2012 — Floral honey as a secondary dressing can promote healing, minimize slough and necrosis, and reduce the affected area of many types of wounds, according to a prospective observational study published online April 12 in International Wound Journal.
Of all the wounds in a study population of European patients who received topical honey as an adjunct to other dressings, 31.4% completely healed and 53.3% improved during an observational period of several weeks, reported Bahram Biglari, MD, from the Department of Paraplegia and Technical Orthopedics, Insurance Association Trauma Centre, Ludwigshafen, Germany, and colleagues. Stagnation occurred in 9.2% of the group's wounds, and 6.1% of the wounds worsened.
Measured as an average total wound surface area for all patients, wound size decreased significantly during the study period, from 29.66 ± 57.57 cm2 (P < 0.05; 2-tailed t-test). Honey dressings also demonstrated a measurable effect on wound cleanliness and patient-reported pain levels.
The study, which received financial support from a manufacturer of Medihoney, lends additional credence to earlier investigations that focused on honey-assisted autolysis and wound debridement.
"I commend Biglari et al in this timely, multicenter study for the treatment of diverse wounds with Medihoney. Obviously, the effect of decreased wound size…demonstrates the effectiveness of honey," wrote Sammy Sinno, MD, from the Institute of Plastic and Reconstructive Surgery at New York University, in an email interview with Medscape Medical News. "This study was a clear demonstration of the effectiveness of honey, particularly Medihoney, in treating wounds."
Dr. Sinno is one of the coauthors of a review article on honey and wound healing that appeared in the American Journal of Clinical Dermatology (2011;12:181-190). He was not involved in Dr. Biglari and colleagues' research.
Researchers enrolled patients treated at 10 medical institutions in Germany and Austria between March 2007 and March 2009. The causes of 154 wounds in the 121-patient study group included general and postoperative wounds, pressure ulcers, soft tissue infections, burns, scalds, and skin lesions. Seventeen patients dropped out, leaving 104 to be included in the treatment assessment. Almost half the participants were younger than 18 years, and nearly one third (32%) were oncology patients.
Investigators applied antibacterial Medihoney alone in 66% of the treatments. In another 22% of cases they used antibacterial Medihoney wound gel, which is composed of 80% honey and 20% plant emollients. They used a combination of both products in 6% of the wounds. In the remainder of the cases they applied honey secondarily to other dressings, including calcium alginate, hydrofiber dressings, and sterile gauzes moistened with isotonic sodium chloride solution.
Investigators changed dressings after 1 to 3 days if they observed wound exudation. They protected wound margins when necessary and cleaned the wounds with sterile solution. The investigators assessed each patient's wounds at least 3 times over observational periods averaging just under 5 weeks.
High tolerance of topical honey was reflected in 89% of the wound assessments.
Wounds were rated as "clean" (grade 1, no slough or necrosis) or "not clean" (grade 0, slough and/or necrosis present). After the application of honey dressings, wound cleanliness improved significantly, from an average grade of 0.16 ± 0.37 to 0.74 ± 0.44 (P < .05; paired Student's t-test).
To assess pain, investigators asked patients to grade the discomfort they felt on a scale of 0 to 10. The total average pain scores reported between recruitment and the end of the observation period decreased significantly, from 1.71 ± 1.89 to 0.55 ± 1.22 (P < .05; paired Student's t-test).
Yet the authors cautioned that "the extent of pain reduction that can be attributed to honey is difficult to evaluate from a non-controlled observational study. A comparative trial with other dressings or remedies would be more conclusive in this regard."
Floral honey drawn from Leptospermum scoparium (manuka) has been shown in many case studies to accelerate healing. And numerous studies have focused on its antimicrobial benefits, especially with regard to antibiotic-resistant bacteria, such as Staphylococcus aureus. The current investigation, however, did not focus on the antibacterial effects of applied honey because physicians had already committed to the use of local antiseptics or systemic antibiotics for conditions afflicting many of the study's participants.
According to Dr. Sinno, Medihoney is one of several honey products that are Food and Drug Administration–approved for wound healing. "I believe [Medihoney] is a safe and efficacious product for the treatment of pressure ulcers and lower extremity ulcers (venous, arterial, and diabetic)," Dr. Sinno wrote. "Although the data is limited, honey also has promise in other wounds including Fournier gangrene, pyoderma gangrenosum, infected surgical wounds, burn and traumatic wounds."
But Dr. Sinno acknowledged that the use of honey for wound healing has not yet reached the mainstream. "Despite a growing number of clinical trials such as the one by Biglari et al, medicinal honey is still not familiar to many wound care practitioners. Based on this study and many others reviews in our review paper…this skepticism is certainly not justified. I think larger, randomized controlled trials in major wound centers across the country would be needed to once and for all put to rest the skepticism surrounding this age-old remedy and help honey find a place in the physician's armamentarium for treating wounds."
One of the study authors disclosed serving as an authorized wound care specialist representing Comvita, the manufacturer of Medihoney, which also funded the study. Dr. Sinno has disclosed no relevant financial relationships.
Int Wound J. Published online April 12, 2012. Abstract
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Cite this: Medicinal Honey Improves Wound Healing, Decreases Pain - Medscape - Apr 30, 2012.