Using Advancis medical grade manuka honey with diabetic foot ulcers

Catherine Gooday, Chief Podiatrist - NHS North Norfolk University Hospitals Trust

Overview

Honey has been used for thousands of years to treat injuries and ailments. The ancient Egyptians were the first to record its’ medicinal use and evidence suggests that they recognised that different honeys had particular characteristics. Aristotle (384-322BC) discussed pale honey as being good for sore eyes and wounds. Diosocrides (c.50AD) described honey from Attica being good for all rotten and hollow ulcers. The healing benefits of honey are also mentioned in the Koran.

In comparatively recent times medical grade Manuka Honey with a UMF® of 10 or above has been found to have properties superior to that of standard honey.

While there is no known case of honey influencing blood sugar levels adversely, it is recommended that the blood sugar levels of patients with diabetes are monitored when using honey.

Necrotic Wounds

(1) Debridement of devitalised tissue by a suitably qualified clinician is recommended for diabetic foot ulcers.

On debridement the extent of the wound bed and any complications should be fully visible and should be treated in relation to the remaining tissue status.

(1) Necrotic tissue and dry debris

Debridement to the base of the wound and healthy vascular tissue is likely in which case it should be treated in the same way as a granulating wound (4).

If stubborn necrotic tissue persists, Activon may be applied via the tube to facilitate autolytic debridement and should be dressed with an absorbant secondary dressing. The dressing should be changed daily to monitor progress and should be debrided accordingly.

Sloughy Wounds

(2) If some or all of the devitalised tissue remains and can not be removed by surgical debridement, apply a layer of Algivon and cover with an absorbent dressing such as Advazorb Plus. The osmotic property of the dressing will facilitate autolytic debridement. and will provide a potent antimicrobial effect.

(2), (3) Sloughy Wound

(3) Highly exuding sloughy wounds may be treated with Algivon and will require dressing change when strike through is evident. A high absorbancy secondary dressing such as Eclypse will maximise wear time.

Granulating Wounds and recently debrided vascular tissue

(4) Likely to be the most common presentation of the diabetic wound due to the process of debridement.

Actively bleeding wounds should be managed appropriately until the bleeding has been stopped prior to dressing with honey.

(4) Granulating Tissue

Wounds with a Cavity

(1) (2) (3) (4) (5)

Algivon is ideal for use with a cavity wound being composed of alginate impregnated with
100% Manuka honey.

For narrow cavity wounds apply Algivon as a packing. The dressing can be cut into a ribbon using sharp scissors. For very narrow sinus wounds with unknown depth consider the use of Activon Tube and cover using an absorbent dressing. An additional layer of Algivon may be applied over the sinus to manage superficial wounds coupled with a cavity.

Epithelialising Wounds

and partial thickness wounds.

(5) (6) Likely to be dry in nature these wounds benefit from a non adherent dressing providing a gentle and slightly moist environment for total epithelialisation. Diabetic wounds will benefit from dressings with gentle antimicrobial properties at this stage to prevent opportunistic bacterial influence and subsequent deterioration. Actilite provides the properties of manuka honey in a malleable mesh form.

(5), (6) Epithelising Tissue

Wounds should be monitored until total closure has occurred and the clinician is satisfied that appropriate palliative care has being provided to remove any predisposition to recurrence.