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The Use of Active Leptospermum Honey Dressings to Re-initiate the Wound Healing Process
Although many new products promise to heal chronic wounds, few have withstood the test of time. Many wounds continue to fail to progress through an organized healing process of homeostasis, inflammation, proliferation, and maturation, becoming chronic wounds that “fail to proceed through an orderly and timely process to produce anatomic and functional integrity, or proceed through the repair process without establishing a sustained anatomic and functional result.”1 Such wounds may be “marked by long duration or frequent recurrence”2 and differ from acute wounds that usually heal in a matter of days or weeks. Chronic wounds have substantial quality-of-life and financial implications for both patients and caregivers.
Wound fluid from chronic wounds has been shown to have low cell mitosis, high levels of inflammatory cytokines, high levels of matrix metalloproteinases, and high pH levels (the latter two are factors in slough production); also present, fibroblasts have been described as “senescent” with a decreased response to growth factors.3 Thus, chronic wounds are described as “stalled,” “stuck,” or “nonhealing”. They need a “jump start” or “kick start” to re-initiate healing. Clinicians treating chronic wounds have described them as “hard to heal” and “frustrating” and the presence or absence of healing has been compared to an emotional roller coaster.4
Over the past 2 years, many clinicians, frustrated with their attempts to heal chronic, nonhealing wounds, have turned to dressings that contain medical grade honey (active Leptospermum or Manuka honey) to re-initiate the healing cascade. Honey has been used since ancient times for wound cleansing and healing. Its rediscovery as a wound dressing is adding to the plethora of evidence regarding its unique components and the properties that influence wound healing. All honeys have a low pH that helps lower the pH of the wound and improve oxygen transport5,6 and high osmolarity that helps draw fluid from the wound and underlying tissues, assisting in debridement of slough and devitalized tissue.7 In fact, honey has demonstrated the ability to debride wounds faster than hydrogels, dextranomer paste, and enzymatic debriding agents.8 Active Leptospermum honey also has been shown to be an effective antimicrobial agent against a wide range of organisms9 and to have anti-inflammatory,10 immunomodulatory,10,11 and antioxidant properties.12
Active Leptospermum honey is the primary component in MEDIHONEY® dressings (Derma Sciences, Princeton, NJ). The Food and Drug Administration cleared these products for use in pressure ulcers, leg ulcers (venous, arterial, and mixed ulcers), diabetic foot ulcers, burns, graft and donor sites, and surgical wounds. Active Leptospermum honey dressings have been used alone or in combination with other advanced wound care therapies to close chronic, nonhealing wounds in the US and abroad.
Often when a new wound healing agent is brought to the market, clinicians initially tend to try the dressings on worst-case-scenario wounds. Over the course of the past 2 years, more than 30 clinical abstracts detailing the use of active Leptospermum honey on these types of train-wreck wounds have been presented at major annual wound care conferences in the US and Canada. Additionally, active Leptospermum honey was the focus of two large-scale randomized controlled studies (more than 200 combined patients) and showed positive results against controls including other advanced wound care modalities.8,13
With this new column, Ostomy Wound Management will integrate the best available research evidence regarding active Leptospermum honey with clinical expertise to advance knowledge for a variety of many challenging chronic wound etiologies. Case studies from various clinical settings will address commonly seen wounds such as venous ulcers as well as less frequently occurring wounds such as malignant cutaneous wounds, vasculitis, hydradenitis suppurativa, calciphylaxis, frost bite, and PIN sites. Making Progress with Stalled Wounds promises to increase your evidence-based knowledge of and comfort with this old/new approach to wound care… a sweet way to begin the new year.
Making Progress With Stalled Wounds is made possible through an unrestricted educational grant from Derma Sciences, Princeton, NJ. The opinions and statements of the clinicians contained herein are specific to the respective authors and are not necessarily those of Derma Sciences, Inc., OWM, or HMP Communications.
This article was not subject to the Ostomy Wound Management peer-review process.
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8. Blair SE, Cokcetin NN, Harry EJ, Carter DA. The unusual antibacterial activity of medical-grade Leptospermum honey: antibacterial spectrum, resistance, and transcriptome analysis. Eur J Clin Microbiol Infect Dis. 2009;28(10):1199–1208.
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10. Tonks AJ, Dudley E, Porter NG, et al. A 5.8-kDa component of Manuka honey stimulates immune cells via TLR4. J Leukocyte Biol. 2007;82(5):1147–1155.
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12. Robson V, Dodd S, Thomas S. Standardized antibacterial honey (Medihoney®) with standard therapy in wound care: randomized controlled trial. J Advanced Nurs. 2009;65(3):565–575.
