A Clinical Minute: Pressure Ulcer Management Using Medicinal Honey

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Peg Manochi, RN, BSN, WCC, CWCN, Clinical Affairs, Derma Sciences Inc, Princeton, NJ

  Even though we have achieved amazing things in medicine, such as organ transplants and proton therapy, pressure ulcers have continued to plague us from the beginning of time. Every facility has a prevention protocol in place, yet pressure ulcers persist as complex and difficult wounds to manage and heal. Here are a few reasons why it might be time to consider MEDIHONEY® as an option in the healing mix.

  Recently published guidelines based on a combined effort of the National Pressure Ulcer Advisory Panel, the European Pressure Ulcer Advisory Panel, and the Pan Pacific Pressure Injury Alliance included recommendations on the use of medical-grade honey to support debridement and treatment of Stage II and Stage III pressure ulcers.1 A randomized clinical trial2 showed pressure ulcers, including 4 full-thickness pressure ulcers treated with medical-grade honey-impregnated dressings, healed faster than those treated with conventional dressings.

  MEDIHONEY® contains active Leptospermum honey and works through 2 key mechanisms of action: 1) it acts as an osmotic engine to draw fluid from deeper tissues to the wound surface to promote removal of devitalized tissue,3,4 and 2) it features a low pH of 3.5–4.5 that helps reduce the pH of the wound and contributes to a wound environment more conducive to healing.5-7 These 2 mechanisms work together to support the removal of necrotic tissue and the development of healthy granulation tissue. MEDIHONEY® is available in multiple formats including a calcium alginate, hydrogel-colloidal sheet (HCS) dressing, gel, paste, and honey colloid.

  The following 2 cases demonstrate how MEDIHONEY® can support removal of necrotic tissue and healing.

Pressure ulcer covered with eschar; Necrotic tissue softened; Successful debridement trajectory with MEDIHONEY.

Case 1

  A 65-year-old patient with multiple myeloma and a hip fracture presented with a Stage IV pressure ulcer that appeared to be several months old.4 The wound was covered with significant eschar (see Figure 1a). MEDIHONEY® Calcium Alginate was initiated with the clinical objective of removing necrotic tissue. After 16 days, the necrotic tissue was markedly softened and was partially sharp debrided at the bedside (see Figure 1b). The use of MEDIHONEY® successfully led to a clean wound bed and at week 7, healing continued to progress as the patient was transferred to a long-term care facility (see Figure 1c).

Deep tissue injury with eschar; MEDIHONEY removed eschar; Clean wound bed.

Case 2

  A patient with multiple comorbidities was admitted to the hospital from a long-term care center with a suspected deep tissue injury.8 Initial wound measurements were 10 cm x 9.5 cm. The tissue evolved into black eschar at which point daily treatment with MEDIHONEY® Calcium Alginate was initiated (see Figure 2a). Within 3 weeks, the eschar was removed and the base of the wound was covered with thick adherent yellow and tan slough (see Figure 2b). MEDIHONEY® continued to effectively support autolytic debridement despite frequent episodes of incontinence requiring daily dressing changes. At 4 months, the wound decreased to 4.5 cm x 4.7 cm and remained infection-free (see Figure 2c). The patient then was lost to follow-up.

  Clinical evidence and clinical experience, as represented in these 2 cases, illustrate how MEDIHONEY® can support autolytic debridement and granulation tissue formation. Adopting this treatment option into your pressure ulcer protocol should be considered to help achieve crucial clinical objectives.

  For more cases on outcomes of the use of MEDIHONEY® in pressure ulcers, visit the MEDIHONEY® Power Webinar series at www.dermasciences.com/medihoney-webinars for a 30-minute case review by Peg Manochi.

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. Haesler E, ed. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Perth, Australia: Cambridge Media;2014.

2. Gunes U, Eser I. Effectiveness of a honey dressing for healing pressure ulcers. J Wound Ostomy Continence Nurs. 2007;34(2):184–190.

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

4. Bridgeman C, Hall C. Use of Active Leptospermum Honey to Heal Pressure Ulcers. A Case Series of Pressure Ulcers. Poster presentation at the Proceedings of Clinical Symposium on Advances in Skin and Wound Care. Dallas,TX. April 2011.

5. Gethin G, Cowman S. Changes in pH of chronic wounds when honey dressing is used. Presented at 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 B, 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.

8. Webb M. Selection of a Cost Effective Debriding Alternative to a Pharmaceutical Enzymatic Agent at One County Long-term Care Facility. Poster presentation at the Proceedings of the American Professional Wound Care Association Conference. Philadelphia, PA. April 2009.