Abstract and Introduction
Abstract
Introduction: Modern wound management continues to present new challenges. Many patients elect to forego operative debridement secondary to high risk, fear, cost concerns, and personal ideologies on healing. Although operative debridement has long been a tenet of proper wound care, alternative innovative approaches to wound management must be considered.
Objective: This case series describes the successful outcomes of 12 patients with dissimilar wounds who were managed with medical-grade honey (active Leptospermumhoney [ALH]) as an alternative to surgery.
Materials and Methods: A case series was identified from clinical experience, chart review, and photographic documentation of all patients evaluated by the acute wound care service. To be included, patients had to decline the recommendation of operative debridement or skin grafting, utilize ALH as an alternative to surgery, and have regular follow-up visits.
Results: Twelve patients with complex wounds were identified and included in this case series. Five patients were considered high risk for surgery due to comorbidities. Seven patients were at low risk for surgery but desired to avoid operative procedures. The use of ALH facilitated autolytic debridement and healing without surgery or hospital readmission.
Conclusions: The properties of ALH include autolytic debridement, bacterial growth inhibition, anti-inflammatory mediation, and cytokine release, making it a viable option for wound management for patients with contraindications to surgery. However, surgical debridement should remain a tenet of wound care in appropriate patients.
Introduction
In the setting of an aging population with increasing incidence of comorbidities, operative intervention is becoming more challenging. In low-risk patients, surgical intervention may be declined secondary to fear, cost, or personal beliefs on healing. The increasing occurrence of complex wounds and infections resistant to antibiotic therapy necessitates the development of wound care treatment alternatives.
The use of honey in wound care has been documented in the literature since the early 20th century.[1] Its use dwindled with the advent of antibiotics in the 1940s. A recent resurgence of use has occurred secondary to new problems with antibiotic resistance, especially in the setting of complex wounds.[1] Honey has many physical characteristics that allow for effective autolytic wound debridement. Its anti-inflammatory properties include modulation of immune cells, monocytes, and B and T lymphocytes as well as stimulation of the release of cytokines to promote healing.[2]
At Christiana Care Health System (Newark, DE; the institution in which this case series took place), there is no standard dressing choice for acute traumatic wound management. In light of this, the authors sought an optimal dressing for their patients who were too high risk for or did not wish to pursue operative debridement. Active Leptospermum honey (ALH; MEDIHONEY; Integra LifeSciences, Plainsboro, NJ) was selected for evaluation secondary to availability, low cost, and the properties of autolytic debridement, bacterial growth inhibition, anti-inflammatory mediation, and cytokine release.[1–4] The purpose of this article is to present a case series of 12 patients who underwent treatment with ALH as an alternative to surgery for dissimilar wounds.
Wounds. 2019;31(2):36-40. © 2019 HMP Communications, LLC
