MANAGEMENT OF LEG WOUNDS/ULCERS WITH HONEY. Ms. Irny Hidaya Binte Muhammad Raffles Hospital Nurse Clinician (Wound Care)

Transcription

1 MANAGEMENT OF LEG WOUNDS/ULCERS WITH HONEY Ms. Irny Hidaya Binte Muhammad Raffles Hospital Nurse Clinician (Wound Care)

2 Outline: Normal Phases of Wound Healing Wound Infection Continuum Non-healing wounds Introduction to Honey and its effectiveness in wound management Sharing of Case Studies

3 Phases of wound healing Injury Vasoconstriction Platelet Aggregation Leucocyte migration Early - neutrophil Chemoattractant release Late macrophages Phagocytosis and removal of foreign body/bacteria Fibroblast proliferation Collagen synthesis Extra cellular matrix (ECM) reorganization Angiogenesis Granulation tissue formation Epithelialization Remodeling Epithelialization ECM remodeling Increase in tensile strength of wound Healed Tissue The four phases of acute wound healing

4 Wound infection continuum Contamination Colonisation Local infection Spreading infection Systemic infection (International Wound Infection Institute, 2016)

5 Biofilm (Phillips et al, 2008)

6 Biofilm and Prolonged Inflammation- Non-healing wounds

7

8 Introduction to Honey Honey is derived from nectar gathered and modified by the honeybee. It is a carbohydrate-rich syrup derived from floral and other plants nectars and secretions. Honey had been used in folk medicine since ancient times. More recently been rediscovered by medical researchers for its use in dressing acute and chronic wounds. Honey reportedly exerts both bacteriostatic and bactericidal activities.

9 Medical Grade Honey Honey in its initial form may contain bacterial spores such as (Clostridium botulinum). Gamma irradiation was introduced to destroy spores that may occasionally be seen in honey.

10 Honey treats First and second-degree Burns Infected and non-healing wounds and ulcers Venous and diabetic foot ulcers Boils Surgical wounds Abrasions Pilonidal sinus In patients suffering from malignant wounds, improvement with respect to wound size and cleanliness was seen after treatment with honey-coated bandages Similarly, honey dressing quickened rates of healing in pressure wounds.

11 Antimicrobial properties Acidity Hydrogen peroxide (H2O2) Found at an acidic ph ranging between 3.2 and 4.5 Aid in bacterial killing by macrophages Prevent microbial biofilm formation and cross contamination Suppress protease activity in wounds because of non-neutral ph which is not favourable for their activities The H2O2 produced by honey is not cytotoxic because its H2O2 concentration is approximately 1000 times lower than that of the 3% solution commonly used as an antiseptic Reportedly stimulates fibroblast proliferation and angiogenesis Osmotic effects Honey is high in sugar; sugars are hygroscopic Water molecules are removed thus creating a nonconducive environment for organism survival, leading to death of bacteria Safe to use in diabetic wounds

12 Anti-inflammatory properties Reduction in the number of white blood cells (Molan, 2002) Reduces vasodilatation therefore reducing edema and exudate Reduce reactive oxygen species and prevent tissue destruction Enhance angiogenesis, proliferation of fibroblasts and epithelial cells by producing certain growth factors like Tumor Necrosis Factor

13 As a deodoriser of malodorous wounds As a debriding/desloughing agent Minimizes scar formation As an agent that maintains a moist wound healing environment Properties of honey As a non-adherent agent that leaves newly granulating tissue intact when an outer dressing is removed

14 Considerations When Using Honey Proper wound assessment is necessary in order to determine the type(s) of product to use Pollen allergy/phenolic compounds from medicinal herbs and dietary plants Honey is not to be used or consumed by infants and young children under 12 months of age due to the chance of botulism poisoning which can cause paralysis and it can be life-threatening

15 CASE STUDIES REVIEW

16 35/F Case Study 1 Presenting complaints and history: Went for varicose vein operation on Right lower limb on 8/12/17 Complicated by nerve damage causing Right foot drop and reduced sensation on the Right lower leg. Seen for the foot drop - advised nerve stimulation & physiotherapy On examination: Right calf swelling seen Thrombosed veins at back of calf post treatment Ulcer popliteal fossa; looks infected

17 Case Study 1 (cont d) 13/2/ /3/2018

18 Case Study 2 71/M Presenting complaints: Non-healing left lower leg ulcer for 2 years with redness around margins Left leg swelling, pain and walking difficulty History: Diabetes Left leg stripping done in 1992 On Examination: Doppler: No DVT, Upper great saphenous vein (GSV) removed. Lower GSV reflux +, small saphenous vein +, Perforator reflux near ulcer laterally Treatment: Endo-venous ablation including perforator ablation

19 Case study 2 (cont d) 12/1/ /1/2018

20 Case Study 2 (cont d) 14/2/ /3/2018

21 Case Study 3 53/M Presenting complaints: Persistent fever, left foot pain, redness and swelling with discharge despite antibiotics, wound exuding yellowish discharge with malodor History of HTN Diagnosis: Left foot DM infection Coincidental DM diagnosis during admission Treatment : Incision and drainage x3 done in OT Copious pus ++ at dorsum of foot, under the MT heads and medial 1st MT head

22 Case Study 3 (Cont d) 23/6/ /6/2017

23 Case Study 3 (Cont d) 23/6/ /6/2017

24 Case Study 3 (Cont d) 3/7/2017-POD Initiated NPWT and Honey

25 Case Study 3 (Cont d) 18/7/2017 Stopped NPWT and continue Honey ointment

26 Case Study 3 (Cont d) 22/9/2017 Honey treatment

27 Case Study 4 36/M Presenting complaints and history: Denies history of DM, HTN, Gout Right ankle insect bite in March Started to blister in June Abscess seen over lateral malleolus. Claims aches at times. Self-dressing. No fever. Made multiple visits to ED and clinic. Treated with Ertapenam, Augmentin and Clindamycin. Examination: Biopsy done to exclude other conditions Diagnosis: Pyoderma Gangrenosum Treatment: Started on oral Corticosteroid but patient discontinue medication without informing

28 Case Study 4 (cont d) 11/9/2017

29 Case Study 4 (cont d) 26/10/ /12/2017

30 Case Study 4 (cont d) 23/2/ /4/2018

31 Case Study 5 66/M Presenting complaints: Forklift rolled over Right leg Fracture mid-shaft fibular Extensive Right shin and calf abrasion History of HTN, No DM Referred for wound management

32 Case Study 5(cont d) 23/6/ /6/2017

33 Case Study 5 (cont d) 4/7/ /7/2018

34 Case Study 5 (cont d) 10/8/ /9/2017

35 Case Study 6 61/F Presenting complaints: Right lower leg swelling x 2 days Started with fever Hospitalization declined despite knowing risks of morbidity and mortality related to worsening sepsis and cellulitis. Diagnosis: Streptococcal erysipelas / severe Skin and Soft Tissue Infection. Examination: Wound c/s done on 8/12/2017- multi drug resistance Acinetobacter baumannii Well demarcated erythema with superficial swelling, markedly edematous, blistering with severe cellulitis Treatment: IV Ceftriaxone 2g in conjunction with oral linezolid started

36 Case Study 6 (cont d) 8/12/2017 8/12/2017

37 Case Study 6 (cont d) 26/12/ /12/2017

38 References: Molan, P. (1999) Why honey is effective as a medicine: 1. Its use in modern medicine. Bee World 80, P. C. Molan, Re-introducing honey in the management of wounds and ulcers-theory and practice, Ostomy/Wound management, vol. 48, no. 11, pp , P. E. Lusby, A. Coombes, and J. M. Wilkinson, Honey: a potent agent for wound healing? Journal of Wound Ostomy & Continence Nursing, vol. 29, no. 6, pp , Simon A, Traynor K, Santos K, Blaser G, Bode U, Molan P. Medical honey for wound care--still the 'latest resort'? Evid Based Complement Alternat Med. 2009;6(2): Malik, K. I., Malik, M. A. N., & Aslam, A. (2010). Honey compared with silver sulphadiazine in the treatment of superficial partial-thickness burns. International Wound Journal, 7(5), doi: /j x x Alam, F., Islam, M. A., Gan, S. H., & Khalil, M. I. (2014). Honey: A Potential Therapeutic Agent for Managing Diabetic Wounds. Evidence-Based Complementary and Alternative Medicine : ecam, 2014, Molan, P. and Betts, J. (2004) Clinical usage of honey as wound dressing: an update. J. Wound Care 13,

39 THANK YOU!