Debridement

caSe 1

 - rheuMatOid arthritiS

A 53 year-old male with a history of rheumatoid arthritis, morbid obesity, myocardial 

injury, and hepatitis C was admitted to the hospital with a new diagnosis of esophageal 

cancer.  He was referred for an evaluation for a foot wound that he had for two and half 

years.  Prior treatments including silver calcium alginate dressings and compression 

bandaging were ineffective.  The patient was evaluated by rheumatology, however 

he refused systemic therapy for the rheumatoid ulcer; chemotherapy for esophageal 

cancer was in progress.  ALH paste was initiated on 5/04/2009, covered with an 

absorbent calcium alginate dressing, and secured with conforming gauze bandage. 

Compression bandaging was refused for edema management.  Complete healing was 

achieved by 9/21/2009, despite continual chemotherapy for esophageal cancer.

Evidence Supporting the Use of MEDIHONEY

®

 

(continued)

Use of ALH on difficult to heal wounds of various etiologies

Nancy Chaiken, ANP-C, CWOCN, Swedish Covenant Hospital, Chicago, IL

Poster presentation 2010, Orlando, FL

26

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References: 1. McFarland A, Smith F. Wound debridement: a clinical update. Nursing Standard.  August 27, 2014;28(52):51-58. 2. Shultz, G et al.: Wound bed preparation, a systemic approach to wound bed management, Wound Rep Regen 11(Suppl):1, 2003.  

3. Downe A. How wound cleansing and debriding aids management and healing. Journal Of Community Nursing. August 2014;28(4):33-37 4. Enoch, S, Harding, K, Wound Bed Preparation: The Science Behind the Removal of Barriers to Healing, WOUNDS,  

2003:15(7).  5. Ramundo J M, Wound Debridement: Acute and Chronic Wounds, R. A. Bryant and D. P. Nix, editors. 2012, Elsevier Mosby, US. p. 279-287.  6. Langemo, Diane, Brown, Gregory, Skin Fails Too: Acute, Chronic, and End stage Skin Failure, Advances 

in Skin and Wound Care, 19(4). 7. Chambers, A. C., & Leaper, D. J. Role of oxygen in wound healing: a review of evidence. Journal Of Wound Care. April 2011;20(4):160-164.  8. Schultz, Gregory S, Mast, Bruce A, Molecular Analysis on the Environments of 

Healing and Chronic Wounds:  Cytokines, Proteases, and Growth Factors, Primary Intention, Feb. 1999. 9. Gethin G, Cowman S. Changes in pH of chronic wounds when honey dressing is used.  In: Wounds UK Conference Proceedings; 13–15 November 2006. 

Wounds UK, Aberdeen.  10. Telgenhoff, D, Shroot, B, Cellular senescence mechanisms in chronic wound healing, Cell  Death and Differentiation, 2005:12, p. 695-698.  11. Wysocki, Annette B. “Evaluating and Managing Open Skin Wound: Colonization Versus 

Infection”, AACN Clin issues adv pract acute Critical Care, Vol 13 (3) August 2002, pp382-397.  12. Cooper, Rose, Cutting, Keith, Romanelli, Marco, Biofilms and the role of debridement in chronic wounds, WOUNDS UK, 2010:6(1).  13. Bryant, R, Nix, D editors, 

Acute and Chronic Wounds, ed 4, pp 279-290, St. Louis, 2012, Mosby.  14. European Wound Management Association (EWMA). Position Document: Wound Bed Preparation in Practice. London: MEP Ltd, 2004.  15. van Rijswijk L, Polansky M. Predictors of time 

to healing deep pressure ulcers. Wounds. 1994;6(5):159–165.  16. Falanga V, Sabolinski ML. Prognostic factors for healing of venous ulcers. WOUNDS 2000;12(5 Suppl A):42A–46A.  17. Sheehan et al. Percent change in wound area of diabetic foot ulcers over 

a 4-week period is a robust predictor of complete healing in a 12-week prospective trial. Plast Reconstr Surg. 2006 Jun;117(7 Suppl):239S-244S.  18. www.worldwidewounds.com/2002/april/Vowden/Wound-Bed-Preparation.html.  19. Herman I. Stimulation of 

human keratinocyte migration and proliferation in vitro: Insights into the cellular responses to injury and wound healing. Wounds 1996;8:33–41.  20. Rao DB, Sane PG, Georgiev EL. Collagenase in the treatment of dermal and decubitus ulcers. J Am Geriatr Soc 

1975;XXIII:22–30.  21. Regulski, M., A novel wound care dressing for chronic leg ulcerations. Podiatry Management, 2008. November/December: p. 235-246.  22. US Department of Health and Human Services. Questions and Answers about FDA’s Enforcement 

Action Regarding UnapprovedTopical Drug Products Containing Papain 2009; Available from:http://www.fda.gov/Drugs/ GuidanceComplianceRegulatoryInformation/EnforcementActivitiesbyFDA/ SelectedEnforcementActionsonUnapprovedDrugs/ucm119646.

htm.  23. Strilko B, Barauskas C, McIntosh A.  A safe and effective alternative for debridement of lower extremity wounds: Active Leptospermum honey dressings.  Proceedings of Symposium on Advanced Wound Care and Wound Healing Society Meeting. April 

2010, Orlando, FL, Poster.  24. Tonks, A.J., et al. (2007) A 5.8-kDa component of manuka honey stimulates immune cells via TLR4. Journal of Leukocyte Biology 82, 1147-1155 DOI: 10.1189/jlb.1106683.  25. Schäfer, Matthias, Werner, S, Oxidative stress in 

normal and impaired wound repair, Pharmacological Research, 2007 doi:10.1016/j.phrs.2008.06.004.  26. Chaiken N. The use of Active Leptopermum Honey on difficult to heal wounds of various etiologies. Proceedings of Symposium on Advanced Wound Care, 

Orlando, FL, 17-20 April 2010 Poster.  27. Milne SD, Connolly P. The influence of different dressings on the pH of the wound environment. J Wound Care. 2014 Feb;23(2):53-4, 56-7.  28. Leveen H, Falk G, Borek B, Diaz C, Lynfield Y, Wynkoop B, Mabunda GA et 

al. Chemical acidification of wounds. An adjuvant to healing and the unfavourable action of alkalinity and ammonia. Annals of Surgery. 1973. 178(6): 745-50.   29. Tsukada K, Tokunaga K, Iwama T, Mishima Y. The pH changes of pressure ulcers related to the 

healing process of wounds. Wounds 1992; 4: 16-20.

MEDIHONEY

®

 Dressing Selection Guide 

For Autolytic Debridement and Healing of  

Superficial, Partial and Full Thickness Wounds

Type of Wound

Eschar

Sloughy

Granulating

Epithelializing

objecTive

Debride

Remove Slough

Promote Granulation

Maintain Moist 

Environment

exudaTe

Dry to Light

Moderate

Light to  

Moderate

Heavy

Light to Moderate

Dry to Light

Medihoney

®

 

dressing  

(primary dressing)

Gel

Paste 

HCS

Calcium  

Alginate

Gel

Paste

Honeycolloid

HCS

Calcium 

Alginate  

Gel 

HCS

Honeycolloid

HCS

xTrasorb

®

 

dressing 

(secondary dressing)

Foam

HCS

Classic

Foam

HCS

Classic

Classic

Foam

HCS

N/A

bioguard

®

  

dressing 

(Teritary dressing)

Conforming 

Bandage or 

Gauze Wrap

Conforming 

Bandage or 

Gauze Wrap

Conforming 

Bandage

Conforming 

Bandage or 

Gauze Wrap

Conforming Bandage

Conforming Bandage

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