Honey dressing: a missed way for orthopaedic wound care

Orthopaedic-related wounds are critical situations calling for care to avoid deep infections and its consequences. Abdel Salam Abdel Aleem Ahmed et al conducted a study to evaluate the efficacy of using honey for care of orthopaedic-related wounds with limited resources. The study was conducted at Department of Orthopaedic Surgery, Benha Faculty of Medicine, Benha University, Farid Nada Street, Kalyubia, Benha, Egypt. It has been published in "International Orthopaedics" journal.

Honey is not only a high sugar-containing solution but also a biological wound dressing having many bioactive components which can enhance wound healing by several mechanisms. Honey accelerates wound healing through actions on its three phases of inflammation, proliferation and remodelling. It has antioxidant and anti-inflammatory actions. This anti-inflammatory effect diminishes oedema and exudate and minimises or even prevents hypertrophic scar formation. It stimulates collagen synthesis, angiogenesis and granulation tissue formation, promotes epithelialisation, and enhances wound contraction. It reduces pain, deodorises the wounds and has a debriding action lifting the debris from the wound. Moreover, the high viscosity of honey provides a protective barrier preventing infection. Honey has antimicrobial effects based on a multitude of factors diminishing the bioburden of wounds.

This prospective study included 50 cases with an average age of 38.18 (range 17–63) years with 38 males and 12 females. The most frequent wound location was the leg (41 patients; 82%), then the foot (six patients; 12%), and the ankle in three patients (6%). The aetiologies were open fractures (34 cases; 68%), infected tibial non-unions (nine cases; 18%), and post-operative infections (seven cases; 14%). Exposed tendon was present in three cases. Bone exposure was present in two cases. Deep infection was present in 29 cases (58%).

Honey dressing was done after meticulous debridement and treatment of the cause, optimising the patient's general condition, blood sugar control in diabetics and strict instructions on smoking cessation.

The dressing started by thorough wound washing with saline and using gauze to remove any superficial debris. No antiseptic was used in the study. After drying the wound, a ribbon of gauze soaked with honey was applied and folded into at least three layers. The used gauze functioned as a mesh keeping honey to prolong its contact with the wound. The gauze length and amount of honey varied according to the wound size for covering the whole wound, filling its depth and hanging over its edges. A dressing was applied over the gauze and a crepe bandage was applied lightly. It was done twice daily or once daily. With improvement of the wound condition, dressings were changed every other day.

The size follow-up was done by monitoring the changes in the maximum wound length longitudinally and horizontally.

Key findings of the study:

• The orthopaedic condition of cases was followed up for a mean of 33.46 (range 22–47; SD 6.61) months.

• Deep samples were taken during debridement from these 29 cases (58%) for culture and antibiotic sensitivity testing. Staphylococcus aureus was found in 12 cases (24%). Other wounds were infected by Staphylococcus epidermidis in seven cases (14%), Klebsiella pneumonia in four cases (8%), Pseudomonas aeruginosa in four cases (8%) and methicillin-resistant Staphylococcus aureus (MRSA).

• Wound sizes were variable. All cases showed improvement in all parameters with complete wound healing and full coverage of bone and tendons.

• Recurrence of deep infection occurred in three cases and treated by debridement. One case needed sequestrectomy of a small exposed tibial cortical fragment.

• Exposed tendon cases showed superficial necrosis which was treated by simple debridement.

• Initial mild itching occurred in five patients with spontaneous resolution.

The authors concluded that – "With treating the underlying aetiology and optimising the patient's general condition, honey was an effective, simple and affordable method of infected wound care in different orthopaedic conditions even with exposed bone or tendons. For the proven biological and antibacterial activities, honey has the potential to be new therapeutic choice which should be considered in the clinical orthopaedic practice for infected wound care."

Further reading:

Honey dressing: a missed way for orthopaedic wound care

Abdel Salam Abdel Aleem Ahmed, Sherif Eltregy et al

International Orthopaedics (2022) 46:2483–2491

https://doi.org/10.1007/s00264-022-05540-9