Choosing appropriate dressings and treatment modalities for
individuals with chronic, non-healing wounds is challenging
due to many underlying, causative factors. The use of
dressings with ALH simplified the decision process. Patients
in this study, with multiple co-morbidities and various wound
types, saw a reduction in slough, and an increase in healing.
As a result, ALH has become this clinician’s product of
choice when there is a need to address the changing wound
environment and multiple underlying causes of non-healing
wounds. Further studies are indicated.
- PreSSure ulcer
A 56 year-old female with a history of abdominal compartment syndrome, cirrhosis of the
liver, acute pancreatitis, congestive heart failure, malnutrition and hepatic encephalopathy,
developed a sacral pressure ulcer after an episode of ischemia. Initially the ulcer
presented as deep tissue injury which then evolved to a stage IV pressure ulcer. The
patient was not a candidate for surgical debridement and progress with alternative
debridement methods was slow. On 4/10/2009 ALH paste was initiated, and covered with
an absorbent calcium alginate dressing daily. Minimal sharp debridement was performed
as needed to remove loosened necrotic slough tissue. Complete healing was achieved
with only small scab by 8/10/2009.
- 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
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
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
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Dressing Selection Guide
For Autolytic Debridement and Healing of
Superficial, Partial and Full Thickness Wounds
Type of Wound
Dry to Light
Light to Moderate
Dry to Light
a guideline for Care
Dressing Application and Removal
Wash hands thoroughly
Assess the wound. Look for signs of healing. Also look for any signs of increased redness, pain, swelling, or heat
within or around the wound*
Cleanse the wound and skin around the wound with sterile saline, sterile water, or other safe wound cleansers
Dry the skin around the wound by patting gently with gauze
Protect the skin around the wound to avoid maceration. Apply a skin protectant barrier wipe or barrier ointment.
(An initial increase in exudates may occur as a result of the highly osmotic effect of MEDIHONEY
Choose a MEDIHONEY
dressing that is appropriate for the amount of drainage. (MEDIHONEY
Gel for light to moderate exudates, wounds that are hard to dress, or those that require a wound