Use of honey as an adjunct in the healing of split-thickness skin graft donor site

Does application of honey improve surgical outcome in pilonidal cyst excision with secondary intention healing? A prospective randomized placebo-controlled clinical trial

Background

Pilonidal sinus disease (PSD) is a common chronic inflammatory debilitating illness caused by ingrowth of hair into the skin. Excision and healing by secondary intention is one of the acceptable managements. The post-operative wound care needs frequent and time-consuming follow-ups. Honey is considered to be a traditional remedy for wound healing. The current study aimed at finding if application of honey could improve surgical outcome in pilonidal cyst excision with secondary intention healing.

Methods

This study was designed as a randomized placebo-controlled parallel assignment interventional (clinical trial) study conducted at the surgical ward of Shahid Beheshti Hospital affiliated to the Yasuj University of Medical sciences, Yasuj, Iran, and was consisted of the 48 patients who underwent surgical resection for PSD with secondary intention healing (24 patients in intervention and placebo-controlled groups). The main element of honey medicinal gel was the unheated natural honey of Dena Biosphere Reserve within the Zagros Mountains. Patients' wounds were visited by a surgeon and a nurse on the days 7, 15, 30, 45, 60, and 90 post-operation. The surgical outcomes including the time to complete wound healing, pain intensity, odor, discharge at the site of surgery, use of analgesics, the time of to return to the daily activities, and occurring of any side effects including infection, erythema, and bleeding were all recorded.

Results

In intervention group, there was significantly lower wound healing time, the lower time to return to the daily activities, lower mean wound volume at the days of 30, 45, 60, and 90 of the follow-up, higher mean post-operative pain level at the days of 15, 30, 45, 60, and 90 of the follow-up, and more usage of analgesics at the days of 15, 30, 45, and 60 of the follow-up. There was no significant difference between intervention and placebo-controlled groups according to the foul smell and fluid discharge at the site of the operation. There were no side effects and complications in both groups of the study.

Conclusions

Application of honey after resection surgery with secondary wound healing is associated with a better surgical outcome and could eventually decrease healing time and reduce duration of return to normal activities, but could increase post-operation pain and analgesic consumption, and no effect on foul smell and discharge.

Trial registration

The project was found to be in accordance to the ethical principles and the national norms and standards for conducting research in Iran with the approval ID and date of IR.YUMS.REC.1399.088 and 2020.05.30 respectively, and is the result of a residency dissertation to get the specialty in general surgery, which has been registered with the research project number 960508 in the Vice Chancellor for Research and Technology Development of Yasuj University of Medical Sciences, Yasuj, Iran, URL: https://ethics.research.ac.ir/EthicsProposalViewEn.php?id=144742

Combined therapy of Ulmo honey (Eucryphia cordifolia) and ascorbic acid to treat venous ulcers

OBJECTIVE

to assess the clinical effect of topical treatment using Ulmo honey associated with oral ascorbic acid in patients with venous ulcers.

METHOD

longitudinal and descriptive quantitative study. During one year, 18 patients were assessed who were clinically diagnosed with venous ulcer in different stages, male and female, adult, with a mean injury time of 13 months. Ulmo honey was topically applied daily. The dressing was applied in accordance with the technical standard for advanced dressings, combined with the daily oral consumptions of 500 mg of ascorbic acid. The monitoring instrument is the assessment table of venous ulcers.

RESULTS

full healing was achieved in 100% of the venous ulcers. No signs of complications were observed, such as allergies or infection.

CONCLUSION

the proposed treatment showed excellent clinical results for the healing of venous ulcers. The honey demonstrated debriding and non-adherent properties, was easy to apply and remove and was well accepted by the users. The described results generated a research line on chronic wound treatment.

Wound care in the wilderness: is there evidence for honey?

Honey is one of the most ancient remedies for wound care. Current research has shown promising results for its use in wound care. This review is intended to inform readers of the physiological properties of honey and the evidence that exists to support its clinical use. When compared with evidence for current wound treatment, honey has proven to be a safe, effective, and sometimes superior treatment for various wounds. There are currently US Food and Drug Administration-approved medical-grade honey products available in the United States. Although there have been no clinical trials exploring the use of honey in wilderness environments, it may be a safe, improvisational wound treatment. More robust studies are needed for definitive conclusions of its efficacy and safety.

Honey in modern wound care: a systematic review

Honey, known for centuries as a topical treatment for a wide range of wounds, has recently known a revival in modern wound care. The objective of this systematic review is to evaluate the available evidence and the role of honey in contemporary wound care. The search strategy was developed in the databases PubMed and ISI Web of Science. Fifty-five studies of any design, evaluating the use of honey in human burns, ulcers and other wounds, written in English, French, German or Dutch were eligible for inclusion. In all three wound categories honey seems to be a dressing with wound healing stimulating properties. In burns there is also evidence for its antibacterial capacity. In general, honey is also been mentioned to have deodorizing, debridement, anti-inflammatory and wound pain reducing properties, although the evidence for these properties is rather limited. Many of the included studies have methodological problems, and the quality of certain studies is low, making it difficult to formulate conclusive guidelines. This review reveals several gaps in the research of honey in modern wound care, and recommendations are suggested for future research.

Post tonsillectomy pain: can honey reduce the analgesic requirements?

Background

Tonsillectomy with or without adenoidectomy is one of the most common surgical procedures performed worldwide, especially for children. Oral honey administration following tonsillectomy in pediatric cases may reduce the need for analgesics via relieving postoperative pain.

Objectives

The aim of this study was to evaluate the effects of honey on the incidence and severity of postoperative pain in patients undergoing tonsillectomy.

Patients and Methods

A randomized, double blind, placebo controlled study was performed. One hundred and four patients, who were older than eight, and were scheduled for tonsillectomy, were divided into two equal groups, honey and placebo. Standardized general anesthesia, and postoperative usual analgesic, and antibiotic regimen were administrated for all patients. Acetaminophen plus honey for the honey group, and acetaminophen plus placebo for the placebo group were given daily. They began to receive honey or placebo when the patients established oral intake.

Results

The difference between acetaminophen and acetaminophen plus honey groups was statistically significant both for visual analogue scale (VAS), and number of painkillers taken within the first three postoperative days. The consumption of painkillers differed significantly in every five postoperative days. No significant difference was found between groups regarding the number of awaking at night.

Conclusions

Postoperative honey administration reduces postoperative pain and analgesic requirements in patients after tonsillectomy. As the side effects of honey appear to be negligible, consideration of its routine usage seems to be beneficial along with routine analgesics.

Honey and wound healing: an overview

Honey has been used to treat wounds throughout the ages. This practice was rooted primarily in tradition and folklore until the late 19th century, when investigators began to characterize its biologic and clinical effects. This overview explores both historic and current insights into honey in its role in wound care. We describe the proposed antimicrobial, immunomodulatory, and physiologic mechanisms of action, and review the clinical evidence of the efficacy of honey in a variety of acute and chronic wound types. We also address additional considerations of safety, quality, and the cost effectiveness of medical-grade honeys. In summary, there is biologic evidence to support the use of honey in modern wound care, and the clinical evidence to date also suggests a benefit. However, further large, well designed, clinical trials are needed to confirm its therapeutic effects.

Honey: its medicinal property and antibacterial activity

Indeed, medicinal importance of honey has been documented in the world's oldest medical literatures, and since the ancient times, it has been known to possess antimicrobial property as well as wound-healing activity. The healing property of honey is due to the fact that it offers antibacterial activity, maintains a moist wound condition, and its high viscosity helps to provide a protective barrier to prevent infection. Its immunomodulatory property is relevant to wound repair too. The antimicrobial activity in most honeys is due to the enzymatic production of hydrogen peroxide. However, another kind of honey, called non-peroxide honey (viz., manuka honey), displays significant antibacterial effects even when the hydrogen peroxide activity is blocked. Its mechanism may be related to the low pH level of honey and its high sugar content (high osmolarity) that is enough to hinder the growth of microbes. The medical grade honeys have potent in vitro bactericidal activity against antibiotic-resistant bacteria causing several life-threatening infections to humans. But, there is a large variation in the antimicrobial activity of some natural honeys, which is due to spatial and temporal variation in sources of nectar. Thus, identification and characterization of the active principle(s) may provide valuable information on the quality and possible therapeutic potential of honeys (against several health disorders of humans), and hence we discussed the medicinal property of honeys with emphasis on their antibacterial activities.

Honey as a topical treatment for wounds

BACKGROUND

Honey is a viscous, supersaturated sugar solution derived from nectar gathered and modified by the honeybee, Apis mellifera. Honey has been used since ancient times as a remedy in wound care. Evidence from animal studies and some trials has suggested honey may accelerate wound healing.

OBJECTIVES

The objective was to determine whether honey increases the rate of healing in acute wounds (burns, lacerations and other traumatic wounds) and chronic wounds (venous ulcers, arterial ulcers, diabetic ulcers, pressure ulcers, infected surgical wounds).

SEARCH STRATEGY

We searched the Cochrane Wounds Group Specialised Register (May 2008), CENTRAL (May 2008) and several other electronic databases (May 2008). Bibliographies were searched and manufacturers of dressing products were contacted for unpublished trials.

SELECTION CRITERIA

Randomised and quasi randomised trials that evaluated honey as a treatment for any sort of acute or chronic wound were sought. There was no restriction in terms of source, date of publication or language. Wound healing was the primary endpoint.

DATA COLLECTION AND ANALYSIS

Data from eligible trials were extracted and summarised using a data extraction sheet by one author and independently verified by a second author.

MAIN RESULTS

19 trials (n=2554) were identified that met the inclusion criteria. In acute wounds, three trials evaluated the effect of honey in acute lacerations, abrasions or minor surgical wounds and nine trials evaluated the effect the honey in burns. In chronic wounds two trials evaluated the effect of honey in venous leg ulcers and one trial in pressure ulcers, infected post-operative wounds, and Fournier's gangrene respectively. Two trials recruited people with mixed groups of chronic or acute wounds. The poor quality of most of the trial reports means the results should be interpreted with caution, except in venous leg ulcers. In acute wounds, honey may reduce time to healing compared with some conventional dressings in partial thickness burns (WMD -4.68 days, 95%CI -4.28 to -5.09 days). All the included burns trials have originated from a single centre, which may have impact on replicability. In chronic wounds, honey in addition to compression bandaging does not significantly increase healing in venous leg ulcers (RR 1.15, 95%CI 0.96 to 1.38). There is insufficient evidence to determine the effect of honey compared with other treatments for burns or in other acute or chronic wound types.

AUTHORS' CONCLUSIONS

Honey may improve healing times in mild to moderate superficial and partial thickness burns compared with some conventional dressings. Honey dressings as an adjuvant to compression do not significantly increase leg ulcer healing at 12 weeks. There is insufficient evidence to guide clinical practice in other areas.

Current techniques in skin grafting

A thorough knowledge of the techniques used in skin grafting is a necessity for successful soft-tissue reconstruction. Careful attention to detail and planning should ensure an excellent outcome. Current research in the fields of tissue engineering and skin substitutes continues to evolve with the ultimate goal being tissue-engineered skin that matches the quality of the autologous skin graft.

Can postoperative pains following tonsillectomy be relieved by honey? A prospective, randomized, placebo controlled preliminary study

OBJECTIVE

To compare the effectiveness of acetaminophen versus acetaminophen-plus-honey following pediatric tonsillectomy and adenoidectomy.

DESIGN

Prospective, randomized, and placebo controlled clinical trial.

SETTING

Tertiary care facility in Ankara, Turkey.

PATIENTS

Sixty consecutive tonsillectomy patients randomized to two groups.

INTERVENTIONS

The acetaminophen group was treated with antibiotics (amoxicillin-clavulonic acid), acetaminophen and placebo, acetaminophen-plus-honey group was treated with antibiotics (amoxicillin-clavulonic acid), acetaminophen, and honey. Visual analogue scale (VAS) was applied for subjective assessment of postoperative pains, while the number of painkillers taken daily and awakening at night due to pain were used for objective assessment. The amount of epithelization was used for assessment of tonsillary fossa recovery.

OUTCOME MEASURES

The difference between acetaminophen and acetaminophen-plus-honey groups was statistically significant both in terms of VAS and number of painkillers taken within the first 2 postoperative days (p<0.001). Although there was no statistically significant difference between groups regarding the VAS scores on the 3rd postoperative day and after, the number of painkillers taken differed significantly until the 8th postoperative day (p<0.001 for first 7 postoperative days; p=0.003 for 8th day). No significant difference was found between groups regarding the number of awakening at night (p=0.36). Tonsillary fossa epithelization was more rapid in the acetaminophen-plus-honey group (p<0.001).

CONCLUSION

Oral administration of honey following pediatric tonsillectomy may relieve postoperative pain and may decrease the need for analgesics. Prospective, randomized, and double-blind studies should further be conducted in order to confirm the data obtained in this study and develop a standard protocol to achieve maximum clinical efficiency.

Diminution de la douleur au site donneur d'une greffe de peau mince par infiltration locale de ropivacaïne (Naropeine®) : résultats d'une série prospective de 30 patients

AIM

The aim of this study was to evaluate the benefits and risks of local infiltration in split-thickness skin grafts donnor site with ropivacaine (Naropein.

MATERIALS AND METHODS

Therefore a prospective study was conducted enrolling 30 patients assessed for split skin grafts to cover muscular flaps, burn areas or primary tumor sites. Donnor site surface ranged from 50 to 200 cm(2). Patients were randomized into two groups: with or without infiltration. Critters of inclusion were age over 18 y.o., donnor site surface below 200 cm(2), no neurological or psychiatic pathology, no contra-indication to ropivacaine. All grafts were performed under general anaesthesia, using Lagrot's razor to take 0.2 to 0.4 mm thickness skin bands. Donnor sites dressings were standardized, associating a corticoid fat dressing (Corticotulle strongly and occlusively contained with an elastic band (Elastoplast. Dressings were removed after three weeks. Immediate and late post-operative pain were evaluated using analogic visual scale (EVA) and need of analgesics during the hospitalisation in our Institution. Side-effects were collected.

RESULTS

Thirty patients were enrolled in this prospective study. They were mean aged 37 years old, sex ratio was 1/1. Donor site surface was mean 157 cm(2) and graft thickness 0.35 mm. There was a significant difference in immediate and late post-operative pain between both groups. Ropivacain reduced pain for the same oral analgesics use during 36 to 48 post-operative hours. No difference was noticed after 48 hours. No side-effects were noticed.

CONCLUSION

Infiltration of split skin grafts donnor site with ropivacain improves postoperative pain during 48 hours. This is a safe and efficient method to improve comfort in addition to a standardized occlusive dressing. It has become a standard routine in our Institution.

Porcine wound models for skin substitution and burn treatment

Skin regeneration is an important field of tissue engineering. Especially in larger burns and chronic wounds, present treatments are insufficient in preventing scar formation and promoting healing. Initial screening of potentially interesting products for skin substitution is usually done by in vitro tests. Before entering the clinic, however, in vivo studies in immunocompetent animals are necessary to prove efficacy and provide information on safety aspects. We have obtained extensive experience using the domestic pig as test animal for studies on skin replacement materials, including tissue engineered skin substitutes, and burn wound treatment. Two models are described: an excisional wound model for testing of dermal and epidermal substitutes and a burn wound model for contact and scald burns, which allows testing of modern wound dressings in comparison to the present gold standards in burn treatment. The results of these experiments show that in vivo testing was able to reveal (dis)advantages of the treatments which were not detected during in vitro studies.