Using Leptospermum Honey to Manage Wounds Impaired by Radiotherapy: A Case Series
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The study product, Medihoney™ Antibacterial Honey (Medihoney Pty, Ltd, Australia), is a mix of Australian and New Zealand Leptospermum honeys (derived from jellybush and manuka nectar, respectively) . The gamma-irradiated (sterile) honey, available in 10- and 20-g tubes, is licensed in the UK and indicated for use in chronic wound care.
Patient 1. In November 2003, 63-year-old Mr. G was diagnosed with vocal cord carcinoma and underwent a course of radiotherapy that was completed in February 2004. His past medical history included chronic obstructive pulmonary disease. As a result of radiotherapy, the skin around Mr. G’s neck and upper chest atrophied and was extremely fragile. He was admitted to hospital in January 2005 with increased hoarseness, weight loss, and dysphagia. A direct laryngoscopy showed an irregular area on the midline/right supraglottic area, which proved to be poorly differentiated invasive squamous cell carcinoma. In early February, Mr. G developed left lower lobe pneumonia. A tracheostomy was performed before total laryngectomy, thyroidectomy, bilateral selective neck dissection IIa, III, IV, and Povox valve insertion. At 15 days post-op, the wound began to break down from the right side of the stoma (see Figure 1a). An area to the left of the stoma broke down 19 days postoperatively (see Figure 1b.)
Although dressings were changed daily, the skin’s fragility and the copious amount of exudate contributed to maceration of the surrounding skin. The wound base to the left of the stoma had a layer of thick slough. The wound to the right of the stoma contained small areas of granulation tissue. During the first week, the wounds were treated with daily applications of hydrofiber rope to manage the exudate but Mr. G found this painful and uncomfortable. To reduce pain associated with the dressing and to assist healing, a hydrofiber rope dressing (Aquacel ™, Convatec Ltd, a division of E.R. Squibb & Sons, princeton, NJ) was soaked with honey before application. This method kept the honey in contact with the wound bed even though this type of wound produces copious amounts of exudate. Daily dressing changes continued due to the amount of wound exudate and honey also was applied directly to the periwound area to reduce and prevent maceration. An absorbent pad was used as the secondary dressing. Because of the tenderness and fragility of the surrounding skin, a paper adhesive tape was used to secure the dressing. After 5 weeks of treatment, the wound to the right of the stoma healed (see Figure 1c) and the wound to the left of the stoma had de-sloughed and was granulating well (see Figure 1d). Dressing change frequency decreased as healing progressed. After 8 weeks, the wound to the right of the stoma remained healed (see Figure 1e). Unfortunately, Mr. G died before the second wound had healed completely; the wound was 80% healed and the remaining area had de-sloughed and was granulating well (see Figure 1f).
It is difficult to know whether the patient’s wound would have gone on to heal with the application of hydrofiber dressings alone. Although no recognized pain scale was employed, Mr. G reported that applying honey lessened trauma to the wound during dressing changes.
Patient 2. In 1988, 93-year-old Ms. H had a squamous cell carcinoma of the left inner canthus of her left eye removed.
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