Article submitted by Clotho Corp: U.S. Distributors of New Zealand Manuka Honey

Note: The information provided in this web-site does not constitute medical advice. It is important that wounds that are not healing are seen by a registered medical practitioner - failure to heal may be the result of malignancy (cancer) or defective blood circulation. Varicose leg ulcers usually require professionally applied pressure bandaging over the dressing to heal successfully.

Excerpts from and article from the Waikato Honey Research Unit

The way honey is used as a wound dressing (practical information)

The following points have come from clinical experience of many people using honey as a wound dressing:

• The amount of honey required on the wound depends on the amount of fluid exuding from the wound. The various beneficial effects of honey on wound tissues will be reduced or lost if small amounts of honey become diluted by large amounts of fluid. Likewise the frequency of dressing changes required will depend on how rapidly the honey is being diluted by fluid.
• Daily dressing changes are usual, but up to three times daily may be needed.
• If the dressing sticks to the wound this indicates that more frequent changes of dressing are needed.
• Exudation of fluid should be reduced by the anti-inflammatory action of honey, so less frequent dressing changes may be needed later - a few days between changes.
• More honey is required on deeper infections, to obtain an effective level of antibacterial activity diffusing deep into the wound tissues.
• Typically, 20 ml of honey (25 - 30 g, 1 ounce) is used on a 10 cm X 10 cm (4 inch X 4 inch) dressing.
• Occlusive (waterproof) or absorbent secondary dressings are needed to prevent honey oozing out from the wound dressing. (Occlusive dressings are better as they keep more of the honey in contact with the wound - absorbent dressings soak the honey away from the wound.) Adhesive tape or bandages can be used to hold the dressings in place if an adhesive occlusive dressing is not used.
• Pressure bandaging is used over the honey dressing for varicose ulcers.
• Dressing pads pre-impregnated with honey are the most convenient way of applying honey to surface wounds. (Dressing pads pre-impregnated with active Manuka honey are available commercially.)
• If pre-impregnated dressings are not available, it is best to spread the honey on the dressing rather than on the wound.
• Abscesses, cavities and depressions in the wound bed are filled with honey before applying the honey dressing pad, so that there is honey in contact with the wound bed. The honey dressings are cut to a size that extends beyond the edges of the wound and any surrounding inflamed area.

Summary

The use of honey as a wound dressing material, an ancient remedy that has been rediscovered, is becoming of increasing interest as more reports of its effectiveness are published. The clinical observations recorded are that infection is rapidly cleared, inflammation, swelling and pain are quickly reduced, odour is reduced, sloughing of necrotic tissue is induced, granulation and epithelialisation are hastened, and healing occurs rapidly with minimal scarring. The antimicrobial properties of honey prevent microbial growth in the moist healing environment created. Unlike other topical antiseptics, honey causes no tissue damage: in animal studies it has been demonstrated histologically that it actually promotes the healing process. It has a direct nutrient effect as well as drawing lymph out to the cells by osmosis. The stimulation of healing may also be due to the acidity of honey. The osmosis creates a solution of honey in contact with the wound surface which prevents the dressing sticking, so there is no pain or tissue damage when dressings are changed. There is much anecdotal evidence to support its use, and randomized controlled clinical trials that have shown that honey is more effective than silver sulfadiazine and a polyurethane film dressing (OpSite®) for the treatment of burns.

Advantages of using honey as a wound dressing

Honey provides a moist healing environment yet prevents bacterial growth even when wounds are heavily infected. It is a very effective means of quickly rendering heavily infected wounds sterile, without the side-effects of antibiotics, and it is effective against antibiotic-resistant strains of bacteria. Its antibacterial properties and its viscosity also provide a barrier to cross-infection of wounds. It also provides a supply of glucose for leucocytes, essential for the 'respiratory burst' that produces hydrogen peroxide, the dominant component of the antibacterial activity of macrophages. Furthermore it provides substrates for glycolysis, which is the major mechanism for energy production in the macrophages, and thus allows them to function in damaged tissues and exudates where the oxygen supply is often poor. The acidity of honey (typically below pH 4) may also assist in the antibacterial action of macrophages, as an acid pH inside the vacuole is involved in killing ingested bacteria. Whether it is through this action, or through preventing the toxic unionized form of ammonia from existing that is involved, topical acidification of wounds promotes healing. The high glucose levels that the honey provides would be used by the infecting bacteria in preference to amino acids from the serum and dead cells, and thus would give rise to lactic acid instead of ammonia and the amines and sulphur compounds that are the cause of malodour in wounds.