Manuka Honey in the Management of Diabetic Foot Wounds
Sarah Bunn- Tissue Viability Nurse Specialist,
Cambridgeshire Community Services,
Luton, England
Introduction
Chronic wounds represent a considerable challenge to health care professionals and a personal burden to clients. Posnett and Franks (2007) estimated that in Britain chronic wounds cost the National Health Service (NHS) in the region of £3 billion per year. This figure will undoubtedly rise due to the ever-aging population and associated co-morbidities such as diabetes, which are known to have adverse effects on wound healing (Morison, Orvington & Wilkie 2004).
Although the majority of literature focuses on the anti-microbial properties of honey, for chronic wounds the management of odour, exudate and the reduction of devitalised tissue are factors that also need to be addressed (Fox, 2002).
Aim
The aim of this case study was to determine if Manuka honey products were appropriate to be included into local clinical guidelines for the management of chronic wounds in diabetic patients.
Case Study
Mr B, a 63 year old diabetic gentleman, attended a nurse led Tissue Viability clinic following referral by his Practice Nurse. He had a 6 week history of burns to both feet which he sustained during a bus trip in India. Due to diabetic neuropathy he had no idea his feet had been burnt until he tried to walk off the bus 3 hours into his journey.
Treatment Plan
On assessment Mr B had 4 wounds, to the soles and sides of his feet. The wounds were covered with between 85 and 100% thick slough. There was maceration at the wound margins and the remaining skin to the feet was dry and cracking.
The main issues identified following holistic assessment were exudate, thick slough, oedema to both feet reducing mobility and risk of infection.
It was questioned which product would be most effective for chronic wounds on diabetic neuropathic feet. Manuka honey was considered although it was a concern that it could possibly increase exudate and cause further maceration.
The following treatment regime was put into place: deep wounds were dressed with a Manuka honey alginate dressing*, superficial wounds were dressed with a Manuka honey contact layer* and the surrounding skin was protected with strips of a thin hydrocolloid dressing. All areas were covered with a non-adhesive foam and held in place with a wide tape. The wounds were measured and photographed at each visit.
Results
After 24 hours there was an increase in exudate so an alternative foam dressing was applied.
After 7 days there was a considerable reduction in slough to all wounds with granulation tissue evident.
After 2 weeks 3 wounds had completely debrided, leaving healthy granulation tissue. The fourth wound had 40% granulation tissue with only 15% thick slough remaining.
After 5 weeks two of the wounds had healed and by 9 weeks all of the wounds had healed with minimal scarring. Mr B. experienced no problems with his diabetic control during the treatment.
Conclusion
Honey has been used since ancient times. It has been described as having many key benefits in relation to wound healing (Molan 2002). These include:
- Moist wound healing
- Autolytic debridement
Stimulation of tissue growth - Antibacterial
- Odour reduction
- Anti-inflammatory
- Scar minimising
These qualities should make honey an ideal tool for wound care practitioners, to aid healing and improve the patients’ experience of coping with a variety of chronic wounds.
In this case study the use of Manuka honey products provided quick debridement of slough and promotion of healthy granulation tissue.
The use of a hydrocolloid dressing to the surrounding skin meant there was no maceration from the initial increase in exudate levels.
There was no evidence of wound infection during treatment and Mr B was able to increase levels of mobility as the wounds healed.
Day 1: Initial presentation of burns
Day 7: Considerable reduction in slough
Week 5: Two of the wounds healed
Week 9: All wounds healed
*This case study was carried out using Algivon and Actilite Medical Grade Manuka honey products supplied by Advancis Medical