Chapter 20: Table of Contents
Honey has also been described and studied as a topical antibacterial treatment that can help control severe bacterial infection in large wounds. In addition to its hyperosmolar antibacterial effects, honey reportedly releases hydrogen peroxide into the wound which helps kill bacteria and promotes an acidic environment that stimulates angiogenesis and growth of fibroblasts. Unpasteurized, commercial honey also contains nutrients and minerals that feed the healing wound bed. Recent studies have also shown that honey has a broad spectrum of antibacterial activity and does not promote bacterial resistance. The author has used bottled, unpasteurized honey to treat wounds of the distal extremities and the body. Bottled honey tends to be messy to use and it subjectively appears to be more painful than sugar at the time of application. After daily debridement and lavage, a sterile gauze sponge or gauze roll is either dipped (sterilely) into the unpasteurized honey or honey is applied to the primary bandage layer and applied directly to a towel-dried wound bed. Secondary, and tertiary bandage layers are then applied to cover the honey-filled primary layer. Although honey appears on paper to be a better option for wound management, this author preferentially use sugar except when the location or the shape of the wound makes honey easier to use (e.g. around an external fixator).
More recently, a commercial honey dressing was introduced on the market – Medihoney®. This primary dressing comes in various forms: calcium alginate (for exudative wounds) and hydrocolloid (for dry wounds) dressings of various sizes as well as hydrocolloid paste that comes in a tube. The Medihoney® dressings are relatively inexpensive compared to other dressings and much easier to use than bottled honey. They can be maintained on less exudative wounds for several days reducing the rate of bandage change and the costs. Their use also prevents contamination of the honey jar during application.
Once the debridement phase is passed and granulation tissue begins to cover the wound bed, the wound can either be closed primarily (delayed primary closure), or it can be left to heal by second intention.