Cath Lab Digest

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  Chronic wounds affect 2.8 million patients in the US and the cost of advanced wound care products is expected to grow to $4.6 billion by 2011.¹ This and the additional costs of loss of income and loss of employment are unbearable for the indigent patient. An investigation was conducted to find a US Food and Drug Administration (FDA)-cleared, safe, effective, cost-efficient, user-friendly, moist wound healing dressing for use in an indigent outpatient wound clinic.

  Over the past decade, researchers have found that active Leptospermum honey (ALH) has unique plant-derived components that make it ideal for managing hard-to-heal wounds and burns.² The components and properties of ALH help prepare the wound bed: high osmolarity helps draw fluid from the wound and underlying tissue, aiding in debridement of slough and devitalized tissue and decreasing edema. Honey has a low pH and a high sugar content, inducing an environment unsuitable for most bacterial growth.³ Studies on lowering wound pH have demonstrated reduction of slough-producing proteases, increase in oxygen diffusion to tissue, and reduction in wound size.⁴ ALH is also high in phytochemicals, which have antimicrobial characteristics reported to clear infection⁵ and reduce or eliminate malodor. Bacteria preferentially metabolize glucose in the honey instead of the amino acids present in tissue and serum, resulting in the formation of lactic acid (instead of odorous amines, sulfur, and ammonia). The antimicrobial action reduces the presence of bacteria and subsequently their ability to cause odor in the wound bed.⁶ ALH does not lose its antimicrobial activity in the presence of wound fluid. Other mechanisms of action specific to Leptospermum honey include immuno-modulatory⁷ and strong antioxidant activity.⁸

  Indigent patients attending an outpatient wound clinic present the following problems: poor patient adherence to care plans, multiple wound types and comorbidities, lack of finances, and poor personal hygiene. It was thought that ALH could be useful in addressing many of these issues due to ease of use, cost effectiveness, cleansing properties, and indications for multiple wound types.

  The following case report describes the use of ALH calcium alginate dressings (MEDIHONEY®, Derma Sciences, Inc., Princeton, NJ) for the management of severely malodorous, highly exuding venous ulcers.

  Case report. A 66-year-old man with diabetes, venous stasis ulcers, and poorly controlled blood sugar presented with infected, foul-smelling, heavily draining wounds on the lateral and medial aspects of both legs. Prior treatment included compression bandaging along with xeroform, silver nonadherent, or silver foam dressings. Despite these efforts, excessive exudate and malodor were offensive to everyone in the outpatient wound center.

  ALH calcium alginate dressings were applied, covered with an absorbent foam dressing, then covered with multilayer compression bandages once weekly. This approach continued until the patient was admitted to a for-profit wound care center and lost to follow-up in our clinic. The odor was eradicated immediately. Exudate and wound size gradually decreased. By week 16, the wounds were well on the way to healing, at which point care was continued elsewhere. The ease of use of this dressing was an important factor with this patient, enabling dressing changes to be performed quickly. Also, the ALH dressings were less expensive than the silver dressings and more effective in controlling exudate and odor.