Cath Lab Digest

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  A fungating tumor wound is characterized by ulcerations (breaks on the skin or organ surface) and necrosis (tissue death) and is usually accompanied by malodor as well as excess exudate, pain, and friable tissue. This type of lesion may occur in many types of cancer (eg, breast cancer, melanoma, and squamous cell carcinoma), especially in the presence of advanced disease.¹ For the patient, the presence of a draining malodorous wound is a continual reminder of the underlying disease process and may contribute to low self-esteem, embarrassment, depression, and social isolation. These devastating wounds are not only upsetting to the patient but also are a challenge to the families and caregivers. Although a plethora of wound care products is available, opinion varies about which dressings to choose for the management of these wounds.

  Active Leptospermum honey (ALH) has been shown to be a cost-effective dressing that can address the challenges of the fungating tumor wound. Through an osmotic process, the high sugar content of honey facilitates movement of fluid from an area of higher concentration to an area of lower concentration. Thus, lymph fluid is drawn from the deeper tissue to the wound surface. This osmotic effect aids in cleansing, debriding, and reducing edema, all key factors in wound healing.

  Additionally, ALH is an effective antimicrobial dressing that inhibits the growth of multiple organisms including bacteria, fungi, protozoa, and viruses. It is effective against antibiotic-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, Pseudomonas aeruginosa, and beta-hemolytic streptococci. No resistance to ALH has been identified, even under conditions where resistance to antibiotics has been induced.²

  Excess inflammation in a wound prevents healing and causes further tissue damage by increasing free radicals within the wound. ALH has been reported to decrease oxidative stress by clearing free radicals.³ In addition, reduced numbers of inflammatory cells have been noted in biopsies of honey-treated tissue and reduced inflammation-associated pain has been reported.⁴ Exudate amount is reduced as a result of reduced inflammation.

  Malodor in a fungating tumor wound has been attributed to the presence of anaerobic organisms that thrive in areas of superficial and deep necrosis. The odor emanates from the unstable fatty acids released as a metabolic byproduct of the anaerobic bacteria. These amino acids produce malodorous ammonia, amines, and sulfur compounds.⁵ ALH has been reported to effectively reduce and even eradicate odor in acute and chronic wounds as a result of the preferential metabolism of honey’s glucose, which produces lactic acid instead of amino acids.

  Regardless of wound etiology, the goal of care when managing a fungating tumor wound is to identify and treat the underlying cause and symptoms of the wound — ie, wound infections, exudate, bleeding, pain, and malodor — in order to promote comfort and improve quality of life.