A Clinical Minute: Honey-impregnated Dressings for Treating Challenging Dehisced Surgical Wounds

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Kara Couch, MS, CRNP, CWS, The George Washington University Hospital, Washington DC

Dehisced surgical wounds can cause many care providers to hit the panic button. These wounds can quickly go downhill: they stall in the inflammatory phase and are usually associated with increased costs of care and length of stay.

Common risk factors for wound dehiscence include obesity, smoking, diabetes, advanced age, low serum albumin, and autoimmune disease. If one or more of these risk factors is present, advanced modalities such as anti-infective surgical dressings, absorptive alginate dressings, or negative pressure are viable options to enhance moist wound healing and keep infection at bay. For dehisced wounds where slough and necrotic tissue are present, surgical or topical debridement also may be used to remove impediments to healing.

Products that can assist in removing slough and necrotic tissue in these dehisced wounds include Manuka honey-impregnated dressings such as MEDIHONEY® dressings (Derma Sciences, Inc, Princeton, NJ). These dressings provide 2 key mechanisms of action to move wounds toward healing: a low pH and high osmolarity. The alkalinity of chronic wounds with slough and necrotic tissue is elevated; MEDIHONEY® Dressings can help lower the pH in the wound environment,1-3 allowing the body’s natural processes to take over. The high osmolarity created by the high-sugar, low-water content in MEDIHONEY® Dressings attracts fluid from deeper tissues to the wound surface to bathe the wound and remove the devitalized tissue.4-6 Together, these mechanisms change the wound environment to conditions that favor healing.

Two cases involving dehisced surgical wounds demonstrate the rapid removal of slough tissue and a timely rate of healing when MEDIHONEY®is implemented.

Case 1.  A man with severe peripheral arterial disease, formerly a heavy smoker for 50 years, had multiple endovascular and open bypass procedures to try to save his ischemic feet. His groin incision dehisced after bypass surgery to a wound depth of 0.4 cm (see Figure 1a). We were concerned because we didn’t want to compromise the prosthetic graft beneath this incision. We applied MEDIHONEY® Calcium Alginate to this wound and 1 day later the wound had filled in 0.3 cm (see Figure 1b). This patient went on to heal using the MEDIHONEY® dressing. OWM_ClinicalMinute_Image1

Case 2. A middle-aged man was in a helicopter accident and suffered trauma to his left knee. Arthroscopic knee surgery was performed, but months later he required total knee replacement because there was too much damage to the knee. On day 4 post surgery, the incision was showing signs of dehiscence at the juncture of the transverse incision from the arthroscopic procedure and by day 14 the dehisced area was 100% covered in slough (see Figure 2a). We were concerned about potential infection because of the implant below the incision. The patient refused to have a muscle flap for wound coverage and elected to proceed with topical treatment. To clean up the wound, we initiated MEDIHONEY® Gel and an absorptive cover dressing and monitored progress. Within 2 weeks (day 30 post surgery), the slough decreased to 80%; by day 42, <10% of the wound was slough-covered. By post op day 90, continued progress and wound edge advancement were noted (see Figure 2b). By month 4, 110 days post op, we achieved complete wound closure without additional surgery, much to the patient’s satisfaction (see Figure 2c). OWM_ClinicalMinute_Image2

Among the various options available to meet the challenges of dehisced surgical wounds, MEDIHONEY® dressings provide simple but effective mechanisms of action, removing slough and necrotic tissue through autolytic debridement and helping support a wound environment that favors healing. 

For more cases on outcomes of the use of MEDIHONEY® in dehisced surgical wounds, visit the MEDIHONEY® Power Webinar series at www.dermasciences.com/medihoney-webinars or a 30-minute case review by Kara Couch. 

References:

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

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

3.         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):745–750.

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

5.         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. 

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

 

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.