Honey on Sloughy Venous Ulcers

   Reference: Gethin, G, Cowman S. Manuka honey vs. hydrogel—a prospective, open label, multicentre, randomised controlled trial to compare desloughing efficacy and healing outcomes in venous ulcers. J Clin Nurs. 2008;Aug 23. [Epub ahead of print]

   Rationale: Expert opinion suggests honey may be effective as a wound desloughing and healing agent. Randomized controlled trials (RCTs) on chronic wounds remain to be conducted.

   Objective: Conduct a prospective RCT to explore the effects of Manuka honey (MH) on VU desloughing and healing.

   Methods: Adult patients with an ankle/brachial systolic blood pressure ratio (ABI) ≥ 0.8 recruited from vascular centers in the United Kingdom, acute care, and community leg ulcer clinics with a VU area < 100 cm2 covered at least 50% in slough, were randomized to weekly treatment for 4 weeks with sustained multilayer high compression and either MH (n = 54) or an amorphous hydrogel (n = 54). The primary wound dressing was covered with secondary hydrocellular foam dressing in addition to appropriate compression. All patients were treated for 8 additional weeks according to investigator preference. Patients taking antibiotics, undergoing immunotherapy, or who had significant nonvenous conditions were excluded. Primary outcomes were percentage of the ulcer covered with slough on week 4 and percentage of patients healed at week 12. Secondary outcomes were decreases in wound size and/or epithelization. Adverse events were analyzed as a measure of safety. Subset healing analysis was performed as a function of Margolis score for VU delayed healing risk,5 which adds 1 risk unit if a VU is ≥ 6 months in duration or ≥ 5 cm2 in area, or 2 risk units if both are true.

   Results: Both groups were comparable at baseline. The percentage of patients healed during 12 weeks was higher (P = 0.03) for MH patients (44%) than for hydrogel patients (33%), and 4-week median wound area was smaller (P = 0.001).
   Manuka honey patients also experienced greater 4-week percentage slough reduction (P = 0.05). Percentage of VU covered with slough declined significantly in both groups from baseline to week 4: from 85% slough at baseline to 29% slough at 4 weeks for the MH group, and from 78% to 43% for the hydrogel group. A nonsignificant trend (P = 0.06) favored the MH group.

   Adverse events were comparable with trends (P = 0.07) for more study VU-related withdrawals: 17 (31%) in the hydrogel group and 9 (17%) in the honey group, and for earlier infection-related study withdrawal in the hydrogel group. The main reasons for withdrawal were study VU infections (hydrogel 22%; MH, 11%) and patient request (5.5% of hydrogel patients, no MH patients).

   Margolis score was strongly associated with 12-week VU healing. The difference between MH and hydrogel percentage healed at 12 weeks persisted (P = 0.025), independent of Margolis score adjustment.

   Authors’ Conclusions: Manuka honey increased healing and desloughing of VUs compared to hydrogel control therapy.

Honey in Wound Care: A Cochrane Review

   Reference: Jull AB, Rodgers A, Walker N. Honey as a topical treatment for wounds. Cochrane Database Syst Rev. 2008;(4):CD005083.

   Rationale: Honey has been used since ancient times in wound care. Preclinical studies and some clinical trials suggest honey may accelerate healing.