A Clinical Minute: Harnessing Medical Grade Honey to Heal Lower Extremity Diabetic Ulcers

Login toDownload PDF version
Ronald Sherman, DPM, FAPWCA, Wound Certified, Multidisciplinary Diabetic Foot and Wound Center, Baltimore, MD

Clinicians treating diabetic ulcers are trained in the science and biology of what is happening on a cellular level. Their organized approach to converting a nonhealing wound takes into consideration adequate blood flow and oxygenation, removal of necrotic tissue or bioburden, edema control, and moisture balance. Like stars, all the elements must align to put the wound on the pathway to healing.

The special characteristics of medical grade honey (eg, MEDIHONEY®, Derma Sciences Inc, Princeton, NJ) are applicable to this organized treatment approach. In the past decade, research looking at medical grade honey — using Manuka as a search criteria — and its relevance in advanced  wound care has spiked. Made with active Leptospermum honey, MEDIHONEY® dressings provide an osmotic effect. They draw moisture from deeper tissues to bathe the wound environment, cleaning out debris and softening and removing necrotic tissue,1-4 enabling the wound to get back on course for healing. MEDIHONEY® dressings also have a naturally low pH (3.5–4.5), helping modulate wound pH,5-7 a benefit often forgotten because we don’t regularly monitory pH levels. Lowering the pH of the wound environment affects the body’s natural processes that, in turn, can impact protease reduction and increase the supply of oxygen. Both characteristics — osmotic pull and low pH — play key roles in both chronic and acute wound healing.

The following cases represent how MEDIHONEY® is harnessed to heal wounds in patients with diabetes and other comorbidities.

Case 1. A 50+-year-old, noninsulin-dependent woman with diabetes has coronary artery disease and hyperlipidemia. She developed fluid overload where a cane injured her dorsal left foot. She exhibited erythema and fever, was admitted to the hospital, and was provided surgical debridement. MEDIHONEY® Gel was initiated on day 3 to help cleanse the wound and modulate the pH. Within 3 weeks, the MEDIHONEY® treatment had autolytically debrided the wound bed and an amniotic tissue product (AMNIOEXCEL®, Derma Sciences Inc, Princeton, NJ) was applied to advance the healing. By day 79 (2.5 months later), this large wound had greatly reduced in size from 3.0 cm x 3.0 cm x 2.0 cm to 1.7 cm x 2.4 cm x 0.1 cm, and we returned to MEDIHONEY® Gel for final closure. In a little more than 3 months (100 days), the wound was healed with the aid of these 2 therapies (see Figures 1a,b,c). owm_0815_clinicalminute_figure1

Case 2. A 56-year old renal transplant patient with diabetes and loss of protective sensation with a medical history including hepatitis A, transient ischemic attack, hypertension, hyperlipidemia, and osteomyelitis had surgery to excise the metatarsal head; the wound dehisced. Treatment included IV antibiotics, 3-layer compression, and absorbent gauze. For the first 28 days, a collagenase ointment was used; however, progress was slow and the wound was not filling in. Treatment was changed to MEDIHONEY®.  Over the next 6 weeks, the wound filled in by 50% and within 10 weeks the wound was healed (see Figures 2a,b,c,d). owm_0815_clinicalminute_figure2

These positive clinical outcomes are an example of how MEDIHONEY® dressings can be harnessed to aid a scientific and organized approach to wound care. No other product combines these 2 mechanisms of action (ie, high osmotic effect and low pH) in 1 product to provide a timely approach to autolytic debridement and healing.

For more cases on outcomes of the use of MEDIHONEY® in diabetic lower extremity ulcers, visit the MEDIHONEY® Power Webinar series at www.dermasciences.com/medihoney-webinars for a 30-minute case review by Dr. Ronald Sherman.

A Clinical Minute is made possible through the support of Derma Sciences, Inc, Princeton, NJ. The opinions and statements provided in A Clinical Minute are specific to the respective authors and not necessarily those of OWM or HMP Communications. This article was not subject to the Ostomy Wound Management peer-review process.

References: 

1. Dunford C. The use of honey-derived dressings to promote effective wound management. Prof Nurs. 2005;20(8):35–38.

2. Chaiken N. Pressure ulceration and the use of active Leptospermum honey for debridement and healing. Ostomy Wound Manage. 2010;56(5):12–14.

3. Gethin G, Cowman S. Bacteriological changes in sloughy venous leg ulcers treated with manuka honey or hydrogel: an RCT. J Wound Care. 2008;17(6):241–247.

4. Regulski M. A novel wound care dressing for chronic leg ulceration. Podiatr Manage. 2008;27(9):235–246.

5. Gethin G, Cowman S. Changes in pH of chronic wounds when honey dressing is used. Wounds UK Conference Proceedings. Aberdeen, UK: November 13–15, 2006.

6. Milne SD, Connolly P. The influence of different dressings on the pH of the wound environment. J Wound Care. 2014;23(2):53–57.

7. Leveen H, Falk G, Borek B, Diaz C, Lynfield Y, Wynkoop BJ, et al. Chemical acidification of wounds. An adjuvant to healing and the unfavourable action of alkalinity and ammonia. Ann Surg. 1973;178(6):745–753.