Medical-Grade Honey as an Alternative to Surgery

A Case Series

Jennifer Bayron, MD; Kathy Gallagher, DNP, APRN, FNP, FACCWS; Luis Cardenas, DO, PhD

Disclosures

Wounds. 2019;31(2):36-40. 

In This Article

Results

Case 1: Traumatic Right Lower leg Wound

A 100-year-old woman with medical comorbidities significant for prior cerebrovascular accident requiring dual antiplatelet therapy and increased pain sensitivity fell backward while trying to sit down, resulting in an injury to her right anterior tibia. On initial evaluation, her wound (measuring 4 cm x 3 cm x 2 cm) was irrigated with normal saline and debrided in the emergency department with loose approximation of the skin flap. The wound then was dressed with oxidized regenerated cellulose [ORC; PROMOGRAN PRISMA; Systagenix, an Acelity Company, Skipton, UK) and gauze.

The patient re-presented 2 days later with necrosis of the skin flap. This required bedside scalpel and gauze debridement but was limited secondary to pain as the patient also suffered from hypersensitivity pain disorder. She underwent a course of wet-to-moist dressings for 2 weeks. Operative debridement was recommended at that time secondary to the burden of eschar and slough, limited ability to perform bedside conservative debridement secondary to patient tolerance, and lack of improvement in the wound 4 weeks after injury. However, the patient was considered at high risk for sedation and was advised to continue her antiplatelet medications for the surgery. Her dressing regimen was changed to ALH gel covered with an occlusive film (Tegaderm; 3M, St Paul, MN) and changed every 3 days to promote autolytic debridement as intraoperative debridement was not an option for this patient.

At each subsequent follow-up, the wound had decreased in size, increased in percentage of granulation tissue, and decreased in amount of slough and/or eschar. The patient's wound healed with minimal conservative bedside scalpel and gauze debridement and ALH 10 weeks after her injury.

Case 2: Posterior Tibial Wound

A 40-year-old man with no medical comorbidities presented with trauma activation secondary to a motorcycle collision. He was found to have a large, irregular-shaped, gaping anterolateral left lower extremity (LLE) laceration that exposed the underlying muscle, fascia, and subcutaneous tissues. His wound was irrigated copiously with normal saline in the trauma bay with removal of any gross debris and was closed in 2 layers, the laceration repair totaling > 30 cm (Figure 1). He was discharged home that night with instructions to clean the wound twice daily with soap and water and to follow up with the acute wound care clinic in 1 to 2 weeks.

Figure 1.

Case 2: (A) day 7 post injury with slough and eschar; (B) 21 days post injury with worsening slough and eschar; (C) 28 days post injury with granulation tissue formation and decreased slough; and (D) 35 days post injury showing granulation tissue and wound contraction.

At his 2-week follow-up appointment, his sutures were removed with a residual wound measurement of 4 cm x 4 cm. The wound demonstrated significant eschar, slough, murky drainage, and swelling. He was sent home on antibiotic therapy and bacitracin for local wound care with follow-up visit 1 week later.

At the 1-week follow-up (3 weeks post injury), worsening eschar and slough were noted. At that time, operative debridement was considered given the volume of eschar, slough, and overlying infected appearance of the wound, but the clinicians proceeded as per patient request with conservative bedside scalpel and gauze debridement in their office and placement of the ALH gel/film dressing.

The wound improved with decreasing necrotic tissue and new healthy tissue growth at each weekly follow-up appointment. Initially, ALH dressing changes occurred daily, but with the improved appearance and decreased exudate, this was transitioned to every 3 days. About 10 weeks after his initial injury, his wound healed without any operative intervention.

Case 3: LLE Injury

A 65-year-old woman with atrial fibrillation on warfarin anticoagulation therapy and a history of cerebrovascular accident, cardiac arrhythmia with pacemaker, and fibromyalgia presented with a LLE injury measuring 2.5 cm x 3.5 cm (Figure 2). On initial evaluation 1 week post injury (Figure 2A), she was found to have an elevated international normalized ratio (INR) of 6, indicating a propensity for bleeding, with an LLE hematoma and overlying cellulitis. Given her multiple comorbidities, she was at high risk for developing wound complications. After appropriate reversal of her coagulopathy, the hematoma was drained at bedside followed with a short course of wet-to-dry dressings to the area. Wound measurement at that time was 4 cm x 6 cm x 0.5 cm.

Figure 2.

Case 3: (A) wound appearance at day 7 post injury; (B) 14 days post injury with hematoma and slough noted; (C) 21 days post injury with decreased slough; and (D) day 40 post injury with decreased slough and granulation tissue formation.

Further bedside scalpel and gauze debridement was performed to partially remove dark eschar, followed by an application of ALH gel and film dressings every 3 days. She was discharged home with an unfortunate lapse in her ALH therapy (lapse from post injury days 7–14).

At 2-week follow-up (Figure 2C), her wound demonstrated 90% eschar and a small hematoma. Operative intervention was considered at this time secondary to burden of necrotic tissue; however, the patient was at high risk for operative intervention secondary to her cerebrovascular and cardiovascular comorbidities and need for uninterrupted anticoagulation therapy. Conservative bedside scalpel and gauze debridement was performed with an application of ALH gel and film dressing. This was further complemented with noncontact low-frequency ultrasound therapy at her next follow-up appointment 1 week later.

Two months after her initial bedside debridement, her wound significantly improved with complete healing by 12 weeks.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....