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Using Active Leptospermum Honey to Jumpstart Stalled Wounds
As the year comes to an end and OWM publishes the final Making Progress column, we hope you have gained valuable insight into the many benefits of active Leptospermum honey (ALH). The use of ALH in varied wound etiologies has resulted in positive patient outcomes, especially in those “train wreck” wounds — stalled wounds that were on the fast track to nowhere. Such wounds got a jumpstart with ALH and began making progress. This farewell piece presents highlights from this series and two new case reports to remind you how ALH can help your patient’s wound make progress toward healing.
The wound healing cascade is a complex and overlapping process. Chronic wounds often get stuck in the early inflammatory phase and fail to progress to the healing phase of inflammation.1 Wound bed preparation is extremely important in moving these wounds back into a more orderly healing progression.
While two strong randomized controlled trials2,3 support the use of ALH in nonhealing venous leg ulcers, many properties of ALH have proven beneficial in chronic and stalled wounds of a wide variety of etiologies.
Honey has been used for thousands of years to help cleanse and debride wounds. Its low pH and a high osmolarity aide in the debridement process and help prepare the wound bed for healing. The high sugar content of ALH produces a fluid shift deep within the wound causing lymph fluid to wash the wound surface, softening the necrotic tissue and promoting debridement. Furthermore, lymph fluid contains plasminogen, which converts to plasmin and aides in fibrinolysis to further deslough the wound bed.
Chronic wounds are known to have a high pH, which contributes to slough formation in nonhealing wounds. Moreover, failure to heal in both chronic and acute wounds is related to the alkalinity of wound bed. Lowering the wound pH may decrease protease activity, increase fibroblast activity, and increase oxygen release, aiding in wound healing. ALH has been shown to reduce the pH of the wound bed — results of a 14-day study that examined the effects of ALH on wound pH levels showed a 0.1 decrease of ion pH, resulting in a total of 8.1% reduction in wound size.1
Case Reports
Over the past year, we have shown that ALH can aide in healing obscure wound etiologies as well as more common yet challenging chronic wounds. One such dramatic wound scenario presented by Nancy Chaiken APN-C, WOCN at the SAWC 2010 conference involved a patient with large dorsal foot wound of 2 years’ duration that was complicated by a methicillin-resistant Staphylococcus aureus infection. Prior treatments with silver alginate and compression bandaging had failed. The patient was started on ALH dressing and within 5½ months, this wound had completely healed (see Figure 1a,b,c).
Similar wound healing was noted by Jason R. Hanft DPM, FACFAS, et al, at a 2009 Diabetic Foot Global Conference (DFCON) conference presentation. A venous leg ulcer of 4-month duration remained nonhealing with standard compression therapy. The wound was further complicated by Klebsiella pnuemoniae and Enterobacter cloacae infection requiring oral antibiotics. ALH-impregnated calcium alginate dressings were applied along with standard compression. Within 29 days, the wound had healed (see Figure 2a,b). 
Summary
In the past 12 months, you have seen the benefits of ALH in cases involving hydradenitis, vasculitis, oncologic wounds, chronic arterial wounds, and nonhealing surgical wounds. Additionally, ALH has been shown useful in diverse patient populations such as pediatrics, persons undergoing radiation therapy, indigent patients, and patients requiring left ventricular assist devices. Due to this widespread utility, ALH is proving to be a David against the many Goliaths of the stalled wound. Although clinicians typically are conditioned to think “salvage therapy” products have toxicity issues and should be used only in dire situations, an important benefit of ALH is its lack of toxicity, which allows its use early in the treatment regimen. Published metrics suggest that chronic wounds that have not healed 15% in 2 to 3 weeks should be considered stalled,4 necessitating a new treatment regimen to progress the wound toward healing. Given its ability to address many of the issues causing wounds to stall, and given its lack of toxicity, ALH should be considered an option as soon as a wound is no longer progressing. This ability to be implemented early in the wound management process, along with its relatively low expense, provides an incentive to try ALH first, as opposed to waiting to see the results of other more expensive treatment options for challenging wounds.
We hope that, over the past year, this column has added to your knowledge of the issues underlying some typical and atypical wound etiologies. Moving forward, we hope you have been inspired to use ALH to make progress with your stalled wounds to help them become healing wounds.
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. Kimberly Stallo is a Clinical Field Specialist, Western Division, Derma Sciences Inc.
This article was not subject to the Ostomy Wound Management peer-review process.
1. Gethin GT, Cowman S, Conroy RM. The impact of Manuka honey dressings on the surface pH of chronic wounds. Int Wound J. 2008;5:185–194.
2. Gethin, GT, Cowman S. Bacteriological changes in sloughy venous leg ulcers treated with manuka honey or hydrogel: a randomized controlled trial [RCT]. J Wound Care. 2008;7(6):241–247.
3. Gethin, GT., Cowmans S, Manuka honey vs. hydrogel — a prospective, open label, multicentre, randomized controlled trial to compare desloughing efficacy and healing outcomes in venous ulcers. J Clin Nurs. 2008; 18(3):466–474.
4. Bell AL, Cavorsi J. Noncontact ultrasound therapy for adjunctive treatment of nonhealing wounds: retrospective analysis. Phys Ther. 2008;88:1517–1528.
