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Use of Honey Products in Lower Limb Lymphoedema and Recalcitrant Wounds 1324557778

Use of Honey Products in Lower Limb Lymphoedema and Recalcitrant Wounds 1324557778

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Published by: enfermagemPT on May 13, 2012
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88
Wounds
UK
, 2011, Vol 7, No 3
Use of honey products in lower limb lymphoedemaand recalcitrant wounds
During this time, the left leg had been treated with gauze and iodine solution or cream, with dressings being changed three times a week.The right leg also had an open ulcer, of eight years’ duration, and had been treatedsimilarly to the left leg in that period.The open ulcers left the already challenged patient, both isolated andhousebound. The wounds were distinctly malodorous, classified as being strongHoney is a viscous, supersaturated sugar solution derived from nectar gathered andmodified by the honeybee,
 Apis mellifera
(Jull et al, 2008).It has been used historically for its therapeutic properties, including, thepromotion of rapid wound healing,reducing oedema, debriding necrotic tissue,reducing inflammation, stimulating tissueregeneration and as a topical treatmentfor infected wounds (Molan, 2002; van der  Weyden, 2003). It can also be effectiveon antibiotic resistant strains of bacteria(Molan, 1992; Cooper, 1999; Cooper andHarding, 1999; Dunford, 2000).Increasing concerns relating to antibioticresistance, as well as the safety or toxicity of topical antiseptic agents, provide theimpetus to search for a safe agent that canassist in the management of infected andcritically colonised wounds and help toprevent infection (Stephen-Haynes, 2005). With this perspective in mind, the authorsused a honey-based product in a patientwith lymphoedema in the lower limb andrecalcitrant wounds.
Case report
This case involved a 45-year-old femalewho suffered from obesity (body massindex [BMI] of 53), who had circular lesions in both her oedematous lower limbs. She had previously been hospitalisedseveral times, for intravenous antibiotics(broad spectrum).
She had mental health problems and lackedfamilial and social support. Her caretakersdid not visit when she was admitted.
The ulcer in the left leg was an open ulcer of 14 years’ duration, with slough, copiousexudation and an unpleasant odour.
Cristina Miguéns is a Registered Nurse with a PhD in Tissue Viability andWound Management at the Community Health Centre Figueira da Foz,Portugal; Fernanda Inglês is a GP and Antonio Jorge Seco is a RegisteredNurse, both at the Community Health Centre Pampilhosa da Serra, Portugal
CASE REPORT
(Haughton, 1995), and the smell waspresent throughout the house.
At first review
At initial presentation, both ulcers wereshallow with a great deal of adherentslough, exudate and a high amount of malodorous fluid, which made it difficult todefine the actual wound size and evaluate the surrounding skin (
Figures 1
and
2
).Swabs were taken from both legs andwere found to be positive for Gram
Figure 1. Left leg — day 0 (20/11/2009).Figure 2. Right leg — day 0 (20/11/2009).Figure 3. Left leg — day 7 (27/11/2009).Figure 4. Right leg — day 7 (27/11/2009).
 
89
Wounds
UK
, 2011, Vol 7, No 3
CASE REPORT
negative bacteriae,
Proteus mirabilis
 showing the highest growth in the semi-quantitative samples. This confirmed theobserved signs of malodour and woundappearance indicating local infection.
Method and observations
The patient was hospitalised at thefirst review (20 November, 2009) in acommunity centre (Pampilhosa da Serra,Coimbra, Portugal).Treatment was started with a honey-based ointment (L-Mesitran
®
, Triticum),which was applied daily and coveredwith crepe bandages (Bastos Viegas). Theaim was to reduce the bacterial burden,debride the slough, and reduce odour (White and Molan, 2005) and oedema.The ointment was used for the firstfourteen days (daily). During this time,autolytic debridement took place (
Figures3
and
4
) showing that the wound wasactually larger than was observed atfirst review.After 14 days of treatment, a switchwas made to a honey hydrogel sheet(L-Mesitran
®
Hydro), with three dressingchanges a week (
Figures 5
and
6
). Woundsize reduced and the periwound arearemained in a good condition.At day 45, because the exudate level wasminimal, the authors decided to change the honey dressing again to the mesh(L-Mesitran
®
Net). This was used twice-weekly, until the end of treatment whencomplete healing had been achieved(
Figures 7
and
10
).
Summary
After three and a half months (106 days)of treatment with the honey products, thepatient’s infected ulcers had successfully healed and she was able to be discharged.During the first 14 days of treatment,dressing changes were undertakendaily, which improved the wound bed(debridement) and the periwoundarea, eliminated malodour and reduced
Figure 5. Left leg — day 14 (04/12/2009).Figure 6. Right leg — day 14 (04/12/2009).
exudate. Thereafter, dressing changes werereduced to thrice-weekly (honey hydrogelsheet), and in the last weeks of treatment,an open weave honey mesh was used.The patient’s arterial permeability wasevaluated by hand-held Doppler: thearterial sign was triphasic in all feetand both leg pulses. Compression therapy with short-stretch bandages(PütterVerband) was initiated atdischarge. These were applied at thecommunity health centre. The final resultwas excellent with good cosmetic results.At six-month follow-up, there was norecurrence of the ulcers and the legswere in a good condition.
Discussion
Lymphoedema, sometimes also calledelephantiasis, is a chronic conditioncharacterised by an abnormal collectionof fluid (lymph) (Macdonald, 2010).Estimates state that one person in 30worldwide is afflicted with lymphoedema(Macdonald, 2010).Results of surgery in upper or lower limblymphoedema are variable (Vignes, 2002).In this case, surgery was not indicateddue to the patient’s obese status (BMI53), as well as her mental problems andfamily situation.Limited information is available on theinfluence of chronic wound healing onfamily life. However, it is clear that caringfor a chronic patient adversely affects the whole family structure (Pitman,2003). Equally, social support positively influences human health (DeVries, 2007)and, thus, in the authors’ opinion, itfollows that family support would alsohave a beneficial effect.In this particular case, the leg woundshad been present for 8–14 years,undoubtedly having a major impact on the patient’s social life and influencingher (already mentally challenged) overallquality of life. The wounds had previously been managed with povidone iodineand gauze.For chronic wound healing, povidoneiodine might not be the best choice, as itreduces both migration and proliferationof fibroblasts in a dose-dependent fashion(Thomas, 2009). Honey-based products,however, promote the proliferation of fibroblasts (DuToit, 2009). This couldexplain why wound healing suddenly progressed at an accelerated pace after 8–14 years of delayed healing.
Conclusion
In this case, the use of honey-basedproducts to heal recalcitrant ulcers in

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