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Management of Diabetic Foot Ulceration With Honey

Management of Diabetic Foot Ulceration With Honey

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Published by: enfermagemPT on May 13, 2012
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09/24/2012

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84
Wounds
UK
, 2011, Vol 7, No 3
Management of diabetic foot ulceration with honey
Odour was not a significantconsideration at this time.
Method/treatment
The authors considered negativepressure wound therapy (NPWT) — a standard protocol with venousinsufficiency — as well as alginateand absorbent dressings as a treatment regimen. However, NPWTis complicated in patients with morecomplex underlying neuropathy, as tooOn average the authors treat 100patients per year for diabetic footulcers at their clinic. Commonchallenges faced include ischemia,osteomyelitis and infections. Treating this type of wound is usually a time-consuming and expensive process,in which the prevention of further degradation of the wound, whichmight lead to amputations, is of primary concern. Unfortunately,amputation can sometimes not beprevented, and (due to the presenceof diabetes) postoperative woundhealing still poses the same challengesas pre-operative treatment. Thisreport describes such a case.
Case report
This 48-year-old male patient hadbeen diagnosed with type 1 diabetesat the age of 21. He had sensitive,motor and autonomic diabeticneuropathy. On December 9, 2009he underwent a transmetatarsalamputation of the right foot due tonecrosis of the toes.The patient uses insulin glargine andlispro to control his diabetes, andpentoxifylline to improve blood flow through peripheral blood vessels.Nifedipine and valsartan are used for his hypertension and rosuvastatine for cholesterol levels.A resection of the fifth metatarsalbone of the right foot took place onApril 14, 2010, as after the transmetatarsal amputation woundhealing was very slow. The resectionleft the bone exposed as well as asurgical wound on the lateral side of  the right foot (10x4x3cm). Thesurgeon decided to leave this to healby secondary intention (
Figure 1
).
Natércia Candeias is an Endocrinologist; Manuel Cardoso is a RegisteredNurse. Both work at the CLINAVIT clinic in Lisbon, Portugal
CASE REPORT
much pressure can be applied withdamaging consequences. In addition, the other dressings were costly and,would not, in the authors’ opinion,promote the necessary patientcompliance and efficacy.On 28 April, 2010 the authorsintroduced a honey-based gel(L-Mesitran
®
Soft, Triticum, NL), whichwas applied twice-weekly (
Figure 2
).Being a gel that is applied as a thin
Figure 2. Fourteen days postoperatively, the start of honey treatment (28/04/2010).Figure 1. Wound three days postoperatively (17/04/2010), measuring 10x4x3cm deep.
 
85
Wounds
UK
, 2011, Vol 7, No 3
CASE REPORT
layer on the wound surface, it wouldnot be invasive. Furthermore, theauthors had seen the results that theproduct could achieve and wanted toevaluate it in their own practice.The sutures were left in place by thesurgeon to achieve primary closure of  the wound. However, after 48 hours they were removed without beingused, as it was thought that this posedless risk of (extra) tissue damage, tissue necrosis and abscess formation.After impregnation with honey gel, the wound was covered withan absorbent charcoal dressing asmalodour had developed whichneeded to be controlled.
 
Due to diabetic neuropathy, thepatient did not complain of any pain,nor was he uncomfortable duringdressing changes.
Results
The wound produced small amountsof exudate, which were absorbedby the secondary dressing. Within16 days since the start of treatment, the wound had reduced in size andgranulation tissue was observed (
Figure3
). Thereafter, the wound continued to progress to healing, and becamesuperficial (
Figure 4
) with firm edges.The wound had completely healed by 1 July 2010 (
Figure 5
), two months after  the start of the honey therapy.Glycaemia evaluation was performedby the patient three times a day. Hisglycaemic level ranged from 90mg/dl to 250mg/dl and his HgA1C was 6.4%,all within acceptable parameters. Thus, the honey dressing did not influence the patient’s glycaemic levels and noadverse events were reported or antibiotics used.
Discussion
Large epidemiologic studies indicate that the incidence of type 1 diabetes
Figure 3. After 16 days of honey treatment (14/05/2010), the wound had reduced in size and granulation tissuewas present.Figure 4. The condition of the wound improved and was now seen to be superficial (10/06/2010).Figure 5. Fully healed wound (01/07/2010).

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