Treating difficult-to-debride wounds using a manuka honey dressing: a case study evaluation

The three main considerations for optimal wound bed preparation are regular debridement to reduce devitalised tissue and encourage formation of healthy granulation tissue, restoration of bacterial balance and promotion of a moist wound-healing environment through exudate management (Schultz et al, 2003). Honey provides a moist wound-healing environment, and is antimicrobial, de-odourising, anti-inflammatory/ antioxidant and debriding — all of which address the key issues in wound bed preparation and bioburden management to promote healing in chronic wounds (Acton and Dunwoody, 2008; Seckam and Cooper, 2013). Honey’s multimodal action justifies its use in a variety of wounds, addresses multiple clinical factors and eliminates the need for multiple products, making it a safe and easy treatment option. The biochemical and antimicrobial components of various honeys differ depending on factors such as floral source, climate and harvesting conditions (Kwakman et al, 2011; Cooper and Gray, 2012). Medical-grade honeys designed for clinical use are specially treated to destroy bacteria and contaminants, are from specific, traceable sources and have proven antimicrobial activity (Cooper and Gray, 2012). Clinicians should be aware that the antimicrobial potency of honey products varies (Molan, 2002; Acton and Dunwoody, 2008). Honey facilitates autolytic debridement by creating moist conditions, although it has also been suggested that the sugar content of honey is involved in activating proteases, which aid the debridement process (Molan, 2009). Honey may also promote autolytic debridement by causing an enzymatic action that activates plasmin, which disintegrates blood clots that bind necrotic tissue to the wound bed (Molan, 2005). A particular kind of honey made from the nectar of the manuka plant (Leptospermum scoparium) found in New Zealand has been shown to be particularly effective in wound bed preparation. Manuka honey is particularly useful in facilitating wound cleansing and autolytic debridement due to its high osmolarity, promoting a moist wound environment and creating an acidic environment conducive to healing (Montoya, 2013; Wahab, 2013). One review also found that manuka honey is more effective at removing attached slough, necrotic tissue and eschar than other types of honey (Molan, 2009).