A Clinical Minute: Limb Preservation: Awaken the Wound for Proper Healing with MEDIHONEY

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Anthony Tickner, DPM, FACCWS, FAPWCA, FAPWH, FADFS Reconstructive Foot Surgeon and Global Wound Consultant, Saint Vincent Hospital/RestorixHealth Wound Healing Center, Worcester, MA

For the complex chronic wound such as a diabetic foot ulcer, achieving wound management goals often can feel like a juggling act, requiring out-of-the-box thinking and multiple products to heal what can seem to be an unhealable wound. The underlying pathology of a diabetic foot ulcer is very complex; if not properly managed, patients are at risk for amputation.

Amputation rates in the United States are staggering at 80,000 per year.1 The mortality rates associated with amputation are as high as some cancers.2 To preserve limbs from amputation, multiple advanced dressings that support moist wound healing combined with hyperbaric oxygen therapy (HBOT), negative pressure wound therapy (NPWT), offloading, and cellular and/or tissue-based therapy are often necessary at different phases of healing. However, if the wound bed is not properly prepared, it can remain challenging to heal.

MEDIHONEY® (Derma Sciences, Inc, Princeton, NJ), through its multiple mechanisms of action, helps prepare an optimal environment for wound healing. Specifically, MEDIHONEY® acts through both its low pH (3.2–4.5) to help modulate alkaline pH common in the chronic wound3 and its high osmolarity to increase wound bed fluid and promote the autolytic removal of nonviable tissue.4-7
MEDIHONEY® can be used throughout the different phases of wound healing and facilitate successful acceptance of advanced therapies such as cellular and/or tissue-based therapies (eg, AMNIOEXCEL® Amniotic Allograft Membrane, registered trademark of BioD, LLC, made available by
Derma Sciences Inc, Princeton, NJ).

The following case illustrates the role of MEDIHONEY® in collaboration with other advanced wound care modalities throughout a complex wound management strategy.

Case Report 

A 54-year-old woman with diabetes, neuropathy, poor circulation, hypertension, high cholesterol, obesity, edema, and depression presented with a left plantar heel ulcer that extended posteriorly up the Achilles. The ulcer had been present for more than 2 years. She resided in a nursing home and was wheelchair-bound. After a previous evaluation at another facility, she was strongly advised to have a below-the-knee amputation. At presentation to our Center (August 11, 2014; see Figure 1), the wound measured 10.7 cm x 6.0 cm (area 64.2 cm2) with 2.5 cm tunneling, heavy drainage, and malodor. The wound had failed to adequately progress following previous treatments with NPWT and various other advanced therapies, including numerous highly absorbent dressings and silver and saline dressings. The patient also received HBOT, which helped, but the wound needed an extra push. MEDIHONEY® was initiated to help awaken and clean out the wound bed, which helped eliminate odor, control exudate, decrease wound size, and facilitate an environment for healing. owm_1215_clinicalminute_figure1

Beginning March 2015, combined and consistent use of MEDIHONEY® and TCC-EZ® for proper offloading, put the wound on a healthy healing trajectory (see Figure 2). On April 9, 2015, the wound measured 4.7 cm x 1.6 cm (area = 7.52 cm2) with 0.2 cm tunneling. MEDIHONEY® was used to prepare the wound bed for the first application of AMNIOEXCEL®. Continued use of MEDIHONEY® and TCC-EZ® helped maintain wound progress. By April 16, 2015, the wound had decreased in size to 3.4 cm x 1.1 cm (area = 3.74 cm2) x 0.2 cm (see Figure 3). A second AMNIOEXCEL® was applied 1 week later. By May 4, 2015, the wound measured 0.7 cm x 0.5 cm (area= 0.35 cm2) x 0.1 cm and was closed May 21, 2015 (see Figure 4). Figure 5 summarizes the case progression.

owm_1215_clinicalminute_figure2owm_1215_clinicalminute_figure3owm_1215_clinicalminute_figure4owm_1215_clinicalminute_figure5

The goals of my clinical practice are to preserve limbs and heal wounds. The dedication to patient care and the use of effective products such as MEDIHONEY® to awaken complex wounds stuck in vicious, nonhealing cycles allows the entire clinical team at St. Vincent’s to heal the unhealable.

Please visit www.dermasciences.com for more information.

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.         Margolis DJ, Malay DS, Hoffstad OJ, et al. Incidence of diabetic foot ulcer and lower extremity amputation among Medicare beneficiaries, 2006 to 2008. Rockville, MD: Agency for Healthcare Research and Quality. January 2011. AHRQ Publication No. 10(11)-EHC009-1-EF.

2.         Robbins JM, Strauss G, Aron D, Long J, Kuba J, Kaplan Y. Mortality rates and diabetic foot ulcers: is it time to communicate mortality risk to patients with diabetic foot ulceration? J Am Podiatr Med Assoc. 2008;98(6):489–493.

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

4.         Gethin G, Cowman S. Manuka honey vs. hydrogel: a prospective, open label, multicentre, randomised controlled trial to compare desloughing efficacy and healing outcomes in venous ulcers. J Clin Nurs. 2008;18(3):466–474. 

5.         Acton C, Dunwoody G. The use of medical grade honey in clinical practice. Br J Nurs. 2008;17(20):S38–S44.

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

7.         Gethin G. Understanding the significance of surface pH in chronic wounds. Wounds UK. 2007;3(30):52–54.