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The Clinical Benefits of Active Leptospermum Honey in Oncologic Wounds
A fungating tumor wound is characterized by ulcerations (breaks on the skin or organ surface) and necrosis (tissue death) and is usually accompanied by malodor as well as excess exudate, pain, and friable tissue. This type of lesion may occur in many types of cancer (eg, breast cancer, melanoma, and squamous cell carcinoma), especially in the presence of advanced disease.1 For the patient, the presence of a draining malodorous wound is a continual reminder of the underlying disease process and may contribute to low self-esteem, embarrassment, depression, and social isolation. These devastating wounds are not only upsetting to the patient but also are a challenge to the families and caregivers. Although a plethora of wound care products is available, opinion varies about which dressings to choose for the management of these wounds. 
Active Leptospermum honey (ALH) has been shown to be a cost-effective dressing that can address the challenges of the fungating tumor wound. Through an osmotic process, the high sugar content of honey facilitates movement of fluid from an area of higher concentration to an area of lower concentration. Thus, lymph fluid is drawn from the deeper tissue to the wound surface. This osmotic effect aids in cleansing, debriding, and reducing edema, all key factors in wound healing.
Additionally, ALH is an effective antimicrobial dressing that inhibits the growth of multiple organisms including bacteria, fungi, protozoa, and viruses. It is effective against antibiotic-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, Pseudomonas aeruginosa, and beta-hemolytic streptococci. No resistance to ALH has been identified, even under conditions where resistance to antibiotics has been induced.2
Excess inflammation in a wound prevents healing and causes further tissue damage by increasing free radicals within the wound. ALH has been reported to decrease oxidative stress by clearing free radicals.3 In addition, reduced numbers of inflammatory cells have been noted in biopsies of honey-treated tissue and reduced inflammation-associated pain has been reported.4 Exudate amount is reduced as a result of reduced inflammation.
Malodor in a fungating tumor wound has been attributed to the presence of anaerobic organisms that thrive in areas of superficial and deep necrosis. The odor emanates from the unstable fatty acids released as a metabolic byproduct of the anaerobic bacteria. These amino acids produce malodorous ammonia, amines, and sulfur compounds.5 ALH has been reported to effectively reduce and even eradicate odor in acute and chronic wounds as a result of the preferential metabolism of honey’s glucose, which produces lactic acid instead of amino acids.
Regardless of wound etiology, the goal of care when managing a fungating tumor wound is to identify and treat the underlying cause and symptoms of the wound — ie, wound infections, exudate, bleeding, pain, and malodor — in order to promote comfort and improve quality of life. ALH dressings have been reported to clear infection, manage exudate, decrease pain and inflammation, and reduce or eliminate odor.6 The following case series of two oncologic hospital patients with fungating tumor wounds support the use of ALH as an effective dressing to meet the challenges of the fungating tumor wound.
Case Reports
Case 1. A 44-year-old woman with locally advanced ductal carcinoma sought treatment for bilateral breast wounds (left breast: 22 cm x 28 cm; right breast: 12 cm x 16 cm). Previous wound treatment included silver sulfadiazine and Dakin’s 0.25% solution. Both were ineffective for exudate and odor management. Papain-urea chlorophyllin complex ointment was prescribed for debridement and odor management until the product was removed from the market. ALH dressings then were initiated for their reported antimicrobial and anti-inflammatory effects and their deodorizing and debriding properties. The wounds were cleansed with a surgical scrub cleanser and rinsed with water and excess moisture was absorbed with gauze. A thin layer of ALH paste (MEDIHONEY®, Derma Sciences, Inc., Princeton, NJ) was applied to all undermined and tunneled areas, followed by ALH calcium alginate, gauze, and absorbent abdominal pads. The dressing was changed daily. The patient continued to receive chemotherapy and radiation treatments. The necrotic slough tissue was rapidly debrided, peeling off in sheets, and ALH’s combined antimicrobial, deodorizing, and debriding properties helped prevent malodor associated with microbial growth and necrotic tissue. The anti-inflammatory properties of ALH provided an analgesic effect, decreasing pain associated with the wound and dressing changes. malodor. The right breast wound completely healed and the left breast wound continues to progress toward healing. The patient and staff are pleased with ease of use, odor eradication, exudate management, and pain-free dressing changes (see Figure 1 and Figure 2).
Case 2. A 61-year-old woman with invasive grade 3 ductal carcinoma and lymphedema of the right arm sought treatment for several open wounds measuring 2 cm x 4 cm on the right breast with slough and a small amount of serous exudate with a foul odor. Her history included a perineal mass and hepatitis B; previous treatment included naturopathic medicine. ALH dressings were initiated — the wounds were cleansed with a surgical scrub cleanser, rinsed with water, and excess moisture was absorbed with gauze. A thin layer of ALH paste was applied to all undermined and tunneled areas followed by ALH calcium alginate, gauze ,and absorbent abdominal pads. The dressing was changed every 3 days. The necrotic slough tissue was rapidly debrided, malodor was immediately eradicated, and the wound healed by the third dressing change (see Figure 3). The patient and staff were pleased with ease of use, odor eradication, exudate management, and rapid healing.
Making Progress With Stalled Wounds is made possible through the support of Derma Sciences, Inc., 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.
1. Dictionary of Cancer Terms. Available at: www.cancer.gov/templates/db_alpha.aspx?CdrID=367427. Accessed October 27, 2009.
2. Blair SE, Cokcetin NN, Harry EJ, Carter DA. Eur J Clin Microbiol Infect Dis. 2009;28(10):1199–2208.
3. Subramanyam, M. Free radical control-the main mechanism of the action of honey in burns. Ann Burns Fire Disasters. 2003;16(3):135–138.
4. Tonks AJ, Dudley E, Porter NG, Parton J, Brazier J, Smith EL, Tonks A. A 5.8-kDa component of Manuka honey stimulates immune cells via TLR4. J Leukocyte Biol. 2007;82:1147–1155.
5. Hampton JP. The use of metronidazole in the treatment of malodorous wounds. J Wound Care. 1996;5)9): 421–425.
6. Barton P, Parslow N, Savage P. Malignant wound management: a patient-centered approach. In: Krasner DL, Rodeheaver GT, Sibbald RG (eds). Chronic Wound Care: A Clinical Source Book for Healthcare Professionals. Malvern, PA: HMP Communications;2007:715–725.
7. Molan P. The evidence supporting the use of honey as a wound dressing. Int J Lower Extremity Wounds. 2006;5(1):40–54.
