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Complete closure

Making Progress 

with Debridement

A discussion on necrotic tissue, the importance of removing  

necrotic tissue from the wound environment, methods of  

debridement, and the role of MEDIHONEY





Debridement is the process of removing devitalized or necrotic (dead) tissue 

from a wound or wound bed until the surrounding healthy tissue is exposed, 

allowing the healthy tissue to granulate and advance the wound through the 

healing process.  Debridement is indicated for any wound, acute or chronic, 

when necrotic tissue, foreign bodies or infected tissue is present. Necrotic 

tissue or foreign bodies within a wound can lead to a negative cascading 

effect causing the wound to become chronic.  Because this effect can lead 

to more serious consequences,including infections such as MSRA and limb 

amputation, it becomes imperative that an effective wound management 

strategy be structured and implemented.  

Primary purposes for debridement are to:




Control and remove infectious materials  

and/or biofilm




 Interrupt the cycle of the chronic wound so 

that protease and cytokine levels more closely 

resemble those of the acute wound




 Reduce bioburden by removing the necrotic 

tissue that supports the growth of bacteria




 Facilitate visualization of the wound edges 

and base for accurate assessment



Causes of Necrotic Burden

Skin Failure


Skin failure happens when skin and underlying tissue die due 

to hypoperfusion, concurrent with severe dysfunction or failure 

of other organ systems.  Determining skin failure is currently 

done by gross examination of muscle mass, subcutaneous 

tissue thickness, wound granulation, and tissue necrosis. 

In addition, stratifying skin failure according to the patient’s 

medical condition can be useful in planning interventions  

and setting treatment goals.  

Skin failure can be typified as acute, chronic and end-stage. 

Acute skin failure occurs when skin and underlying tissue die  

due to hypoperfusion concurrent with a critical illness.  Mortality 

rates range from 33% within 30 days to 73.3% within 1 year of 

onset of skin failure in the intensive care population.  

Chronic skin failure is an event in which skin and underlying 

tissue die due to hypoperfusion concurrent with a chronic 

disease state. It typically happens more steadily over time, 

and in older individuals.  Multiple co-morbidities combined 

with other age-related declines can accelerate degeneration. 

Deterioration of internal organs can manifest in the external 

organ of skin.

End-stage skin failure occurs when skin and underlying tissue  

die due to hypoperfusion concurrent with the end of life.

Necrotic Tissue and Necrotic Burden

Necrotic or avascular tissue is the result of an inadequate 

blood supply to the tissue in the wound area.  It contains dead 

cells and debris that is a consequence of the dying cells.


There are different types of necrotic tissue including eschar 

and slough.  Avascular tissue exposed to the air will form a 

hard black crust known as 

eschar. If kept moist, avascular 

tissue will appear brown, yellow or gray and soft, flimsy or 

stringy.  This tissue is called 

slough.  Slough is fibrinous 

tissue consisting of 

fibrin, bacteria, intact leucocytes, 

cell debris, serous exudates and DNA.  After eschar is 

debrided, slough may be present as the wound is not 

completely clean. Thereafter, if a moist wound environment 

is not maintained, continued exposure to air may dessicate 

remaining slough, causing eschar to reform.

4, 5

Necrotic burden is the combination of necrotic tissue, 

excess exudate and high levels of bacteria present in 

dead tissue that accumulate in chronic wounds.  Necrotic 

burden creates an altered cellular environment (elevated 

pH, proteases, biofilm, free radicals) which causes a 

cascading effect that can prolong the inflammatory 

phase, obstruct wound contraction and impede the 








FibrinOuS tiSSue 

lack OF blOOd FlOw Or lack OF tiSSue PerFuSiOn


Lack of blood flow or lack of tissue perfusion can be caused by 

occlusion, vasoconstriction, venous hypertension, hypotension, 

dehydration, medications, radiation, smoking, and inability to 

transport O


.  O


 fuels the cellular functions essential to the 

repair process, making it critical to wound healing.  Lack of 

blood flow causes a decrease in oxygen, slowing or stalling the 

healing process. 

elevated PrOteaSe activity

Elevated protease activity may occur in chronic wounds and 

may inhibit healing by degrading extra-cellular matrix proteins, 

growth factors, their receptors and protease inhibitors.



Protease activity can potentially be reduced by lowering  

the pH of a wound.  This also may result in increased oxygen 

release, enhanced destruction of abnormal wound collagen, 

and increased macrophage and fibroblast activity.


Free radicalS

Non-healing wounds typically display increased reactive 

oxygen species (ROS). ROS are deleterious in excess amounts 

due to their high reactivity, which causes oxidative stress.  

This is associated with reperfusion injury, one of the primary 

factors in chronic wound development.  In the chronic wound 

environment, ROS attack DNA, causing an accumulation of 

lipofuscine (which the cell cannot degrade) and DNA damage-

induced cell cycle arrest.


  Tight regulation of ROS production 

and detoxification is crucial for the repair process in wounds.

inFectiOn and biOFilM

An infection is the presence of replicating microorganisms 

invading wound tissue and causing damage to the tissue 

and the host.  Biofilms, created in the presence of a bacteria, 

are complex polymicrobial communities attached



a substrate, covered with an extracellular polymeric 

substance (EPS).  Biofilms and their causative organisms 

are not visible to the naked eye, and conventional 

swabbing is often inconclusive in identifying them.  Biofilms 

repopulate in toxic wound environments in which cells 

break down and chronic inflammation occurs.  This is 

exacerbated by the release of planktonic bacteria from 

the biofilm, which stimulates an inflammatory response.



Persister cells can repopulate the biofilm despite antibiotic 

susceptibility and therapy.

FOreign bOdieS

Finally, external factors such as foreign bodies can 

complicate wound management.  Debris (projectiles, 

splinters, glass and shrapnel), and even fragments of 

dressing and suture material, must be removed as they  

can interfere with healing. 



importance of Optimizing and controlling the wound bed environment

A wound management plan should include a thorough wound assessment and selection of products 

capable of addressing the specific needs of the wound.  Setting goal oriented strategies to gain control 

over the wound environment will help get the wound back on track towards healing.  Appropriate goals 

such as maintaining the physiologic wound environment (e.g., debridement, cleansing, prevention/

management of infection)


 and providing systemic support (e.g., edema reduction, nutrition, hydration) 

are the foundation to the process.

When necrotic tissue is present, there are a number of related factors that could be the root cause of 

delayed healing: 



  Non-resolving inflammation




Bacterial infection or 10


 organisms per gram of wound tissue




Elevated levels of proteases




Impaired perfusion and decreased tissue oxygenation or oxidative stress

Removal of necrotic tissue is therefore fundamental to allowing the wound to progress and has many 

beneficial effects.  Proper debridement removes and reduces the barriers that impede the healing process 

and provides an environment that stimulates the growth of healthy tissue needed for wound healing.



defining Stalled wounds

Stalled wounds are generally considered those that do not heal at least 15% in two weeks.  For example:


  Pressure ulcers that do not progress at least 39% in two weeks may not heal in a timely fashion



  Venous leg ulcers that do not heal at least 30% in two weeks will probably not heal in six months



   Diabetic ulcers that do not heal 30% in two weeks have only a 9% chance of healing in three months



Prepare the wound bed and promote moist wound healing.

Tissue management


Moisture balance



(edge) advancement



Infection and  

inflammation control

time Management

Proper wound bed preparation is essential to promoting the wound healing process.  Utilizing the Time 

Management protocol will help to keep that wound on track.

Autolytic debridement


uses the body’s own enzymes 

and moisture to re-hydrate, soften and finally liquefy eschar 

and slough.  During autolysis, enzymes present in the wound 

have the effect of liquefying non-viable tissue.  Clinicians foster 

autolytic debridement by utilizing moist wound dressings.  By 

maintaining a moist wound environment, the body is able to 

use its own processes to eliminate necrotic tissue.  Autolytic 

debridement can be achieved with the use of occlusive or  

semi-occlusive dressings which maintain wound fluid in contact 

with the necrotic tissue. It is virtually painless for the patient and 

safe, yet is generally  slower than other forms of debridement. 

It can be used on its own, after surgical debridement, or in 

conjunction with enzymatic or mechanical debridement. 

Mechanical debridement

 is a process in which force is 

exerted on the necrotic tissue to rip, pull, push or abrade away 

the devitalized tissue from the healthy tissue.  Mechanical 

debridement is often non-selective and may remove or cause 

damage to healthy tissue as well as necrotic tissue.  Examples 

of mechanical debridement include wet-to-dry dressings, wound 

irrigation, pulsitile lavage, whirlpool, contact ultrasound and 

scrubbing the surface with gauze.  Wet-to-dry dressings do not 

provide a moist wound healing environment and are not optimal 

for wound care once the wound is free of necrotic tissue. 

Sharp debridement

 is the removal of devitalized tissue by 

a skilled clinician, typically using a scalpel, scissors, curette 

or other sharp instrument.  Clinicians use conservative sharp 

debridement to remove loosely adherent nonviable tissue at 

the bedside or in a clinical setting.  Surgical debridement is 

done by a physician usually in the operating room, under 

anesthesia, with instruments and/or a laser when the tissue 

removal needs are extensive, or when the patient has a 

serious infection associated with the wound.  Although 

sharp debridement is fast, it is non-selective and can be 

very painful to the patient. 

Enzymatic debridement,

 or chemical debridement, 

makes use of certain enzymes and other compounds to 

dissolve necrotic tissue.  It requires a prolonged period 

of enzyme activity, and a moist wound environment with 

appropriate pH and temperature.  Enzymes are inactivated 

by metals in some wound care products (silver, zinc).



The enzyme used in the U.S., collagenase, digests collagen 

in necrotic tissue by dissolving the collagen “anchors” that 

secure the avascular tissue to the wound bed.  Collagenase 

has been shown to be most active within a pH range of 6 

to 8.

19, 20


Biologic debridement

 uses maggots grown from the 

sterilized eggs of Lucilia sericata.  The larvae are placed 

in the wound bed, where it is theorized that they secrete 

proteolytic enzymes that break down necrotic tissue, which 

they then ingest.  This is considered an option when the 

patient is not a surgical candidate and has not responded 

to other methods of debridement.


Types of Debridement


The standard methods of debridement are autolytic, mechanical, enzymatic, sharp and biologic.  The method 

of debridement used, often depends on the amount of necrotic tissue present in the wound bed, the extent of 

the wound, and the patient’s medical history and overall condition.  Clinicians sometimes use more than one 

debridement method in conjunction in order to achieve the most successful removal of necrotic tissue.

Continual vs. intermittent debridement

It has been found that rates of healing increase when wounds are debrided more frequently.


  With the increased 

knowledge of biofilms and their ability to repopulate, as well as the damaging effects of elevated proteases (MMP’s) 

of the chronic wound, more focus has been placed on continual debridement vs. single or intermittent debridement. 

Continual debridement provides a consistent action of removing necrotic tissue from the wound bed over a period of time, 

unlike single or intermittent methods.  The ability to provide continual and consistent removal of necrotic tissue helps to 

create an optimal environment for healing and allows for less disruption to the wound bed.

The Role of




The overall goal for wound bed preparation is to remove factors that delay healing.


  These factors in a 

stalled or chronic wound include necrotic tissue and altered levels and composition of wound exudates. 



 dressings, containing Active Leptospermum Honey (ALH), address factors that cause 

delayed healing in chronic wounds.  As demonstrated in multiple RCTs and 100s of clinical papers, 

ALH helps to jump start wounds and promote autolytic debridement due to its multiple mechanisms of 

action.  MEDIHONEY


’s osmotic effect addresses multiple aspects of debridement quickly for optimal 

patient care.  The high sugar content of MEDIHONEY


 aids in the increased flow of fluid to support the 

continual cleansing of the wound environment, helping to remove devitalized or necrotic tissue through 

an osmotic effect.

21, 22

  Additionally, the low pH of MEDIHONEY


 helps to lower the pH levels within 

the wound environment,


 which has been shown to have wound healing benefits.




autOlytic debrideMent

During autolysis the body breaks down tissue or cells. A moist environment, created by ALH dressings, aids the 

body’s own process of moisturizing and re-hydrating, thus loosening and liquefying necrotic tissue.

high OSMOtic POtential

ALH creates an osmotic effect, which occurs when the high sugar content of honey facilitates movement 

of fluid from deeper tissue toward the wound surface.  The increased flow of fluid helps the body’s natural 

processes to cleanse the wound, removing debris and necrotic tissue. 

reductiOn in ph

The failure of a chronic wound to heal has been correlated with alkaline pH levels.


  The surface pH of chronic 

wounds has been reported to range from 7.15 to 8.94.


  ALH has a low pH of 3.5 – 4.5, which impacts the 

wound helping to reduce the pH of the wound environment.

9, 27

  Lowering the pH can help aid the body’s 

natural reparative processes that support the removal of dead tissue and wound healing.




High Osmolarity

Wound bed



Low pH Level


ound Healing


ound Br

















Active Leptospermum 

Honey pH: 3.5– 4.5


clinical iSSue

Topical products containing papain, used for removal of 

necrotic tissue, control of inflammation, reduction of wound 

odor, and rehydration of the skin, are no longer approved 

for use in the United States.


 With the loss of papain-urea 

based debridement agents, there was a need to find a safe 

and cost-effective alternative for debridement of non-viable 

tissue and for wound bed preparation.


incluSiOn criteria

Five patients were asked to participate in an open label 

pilot study. Selection criteria were limited to lower extremity 

ulcers with a minimum of 50% devitalized tissue.  Active 

Leptospermum Honey (ALH) has experienced increased 

attention in the literature as an effective agent to promote 

autolytic debridement.

9, 25

  Many patients in the outpatient 

setting are not candidates for surgical debridement. 


To determine the efficacy of this product for debridement 

of devitalized tissue as an adjunct to a successful wound 

treatment program.

treatMent PrOtOcOl

In each case an ALH calcium alginate dressing was applied 

to non-viable tissue and covered with an absorbent cover 

dressing.  Dressings were changed every other day or one to 

two times per week or as needed for strike-through. Wound 

photography was performed on a weekly basis to document 

progression of debridement.


Dressings with ALH demonstrated the ability to promote 

debridement of necrotic tissue for five patients with lower 

extremity non-healing wounds.  Several patients who were 

unable to tolerate hydrogel therapy reported improved 

dressing tolerance with the use of ALH.  Improvement 

in all wounds was documented. There was a decreased 

percentage of non-viable tissue, increased percentage 

of granulation tissue,  and increased dressing tolerance. 

The investigators confirmed that ALH dressings were an 

effective, first-line choice for debridement and wound bed 

preparation for these cases.


Debridement is a vital part of the successful management of 

chronic wounds.  ALH’s ability to effectively aid debridement 

was observed in this group of five patients with differing 

wound types.  Additional improved dressing tolerance were 

noted.  The dressings were easy to use and well received 

by caregivers and patients.  As a result ALH dressings are 

considered an adjunctive therapy for successful wound 

treatment in our program.  Further studies are indicated.

Evidence Supporting the Use of MEDIHONEY


 Debridement of lower extremity wounds with ALH

 Becky Strilko RN, BSN, CWOCN, APN; Chris Barkauskas RN, BA, CWOCN, APN;  

  Andrea McIntosh, RN, BSN, CWOCN, APN, Silver Cross Hospital, Joliet, IL

 Poster Presentation, April 2010,  Orlando, FL


caSe 1

 - venOuS ulcer

A 63 year-old female with a history of venous ulcer disease and Sjögren’s syndrome presented 

with three full thickness, non-healing ulcers of the right posterior leg.  She reported being 

“terrified” of surgical intervention and steadfastly refused sharp debridement.  Persistent, 

consistent “bad” pain was reported as 4-6 on a 0-10 visual analog scale.  Medications included 

hydrochlorothiazide and propoxyphene napsylate as needed for pain.  Previous treatments with 

triple antibiotic ointment and papain-urea-chlorophyllin complex ointment were ineffective for 

the promotion of wound healing.  Initially, the wounds measured 1.0 cm x 1.0 cm, 5.0 cm x  

2.0 cm x 0.2 cm, and 1.5 cm x 1.5 cm with scant exudates and 100% eschar; hydrogel therapy 

was prescribed to promote autolytic debridement.  Increased pain was noted with hydrogel 

therapy (6-8 on a 0-10 visual analog scale).  ALH calcium alginate was initiated on 9/15/2009, 

covered with an absorbent cover dressing and changed one to two times per week.  Gradual 

wound improvement was noted; the patient reported, “The dressings are natural and I did not 

need surgical debridement.”


Evidence Supporting the Use of MEDIHONEY


 Debridement of lower extremity wounds with ALH

 Becky Strilko RN, BSN, CWOCN, APN; Chris Barkauskas RN, BA, CWOCN, APN;  

  Andrea McIntosh, RN, BSN, CWOCN, APN, Silver Cross Hospital, Joliet, IL

 Poster Presentation, April 2010,  Orlando, FL


caSe 3

 - trauMatic wOund

A 53 year-old female with a history of hypertension, hyperlipidemia and bipolar disorder sustained 

a traumatic wound on the left anterior tibial region in a motor vehicle accident in May of 2008. 

Prior topical antimicrobial therapy (silver sulfadiazine) was ineffective for the promotion of wound 

healing.  Her medications included valproic acid, bupropion hydrochloride, a multivitamin, and 

zinc supplement. She presented to the wound care center on 9/24/2009 with a full thickness 

wound with 90% slough and 10% granular tissue with a moderate amount of serosanguinous 

exudates.  ALH calcium alginate was initiated, covered with compression bandaging and changed 

once per week.  Within one week slough was eradicated, exudates decreased; the patient 

reported the dressings were “comfortable”.  A skin graft was performed for final wound closure.

caSe 4

 - trauMatic wOund

A 60 year-old healthy male taking no medications sustained two full thickness wounds on the 

right patella from a motorcycle accident.  Initial surgical debridement was performed.  He 

presented to the wound center two weeks later on 10/13/2009 with two full thickness wounds 

with 100% granulation tissue.  Hydrogel therapy was prescribed to promote moist wound healing.  

One week later the base of each wound was covered with 90% slough, moderate amounts of 

wound exudates were noted.  ALH calcium alginate dressings were initiated, covered with an 

absorbent cover dressing and changed every other day.  The patient reported complete healing 

was achieved by week six. 

caSe 5

 - trauMatic wOund

A 77 year-old female with hypertension and COPD sustained an injury to her right lateral leg on 

12/15/2009.  The patient was taking the following medications: fluticasonepropionate/salmetrol 

inhalation powder, multivitamin, tiotropium bromide, albuterol sulfate, furosemide, diltiazem 

hydrochloride, prednisone, and travoprost ophthalmic solution.  She presented to the wound 

center on 1/21/10 with a 5 week-old full-thickness wound surrounded by erythema and edema. 

The wound measured 6.0 cm long x 2.5 cm wide x 0.3 cm deep with minimal exudates.  The 

base of the wound was completely covered with slough (50%) and eschar (50%). Previous 

treatments with topical antimicrobial therapy, including silver sulfadiazine x 1 week and silver 

wound gel x 1 week, were ineffective for the promotion of wound healing.  ALH calcium alginate 

dressings were initiated on 1/27/2010, covered with an absorbent conforming gauze and  

secured with an adherent cohesive bandage once weekly. Within two weeks slough, eschar, and 

erythema were decreased.

caSe 2

 - PreSSure ulcer

An 89 year-old male with a history of coronary artery bypass graft, congestive heart failure, 

atrial fibrillation, chronic renal failure, and gout presented to the wound care center with an 

unstageable pressure ulcer on the left heel.  The patient was taking the following medications: 

amlodipine besylate, levothyroxine sodium, niacininaide, valsartan, finasteride, allopurinol, 

furosemide, simvastatin, terazosin hydrochloride, and clonidine hydrochloride.  Previous 

treatment with hydrogel therapy to promote debridement was ineffective.  ALH calcium alginate 

dressings were initiated on 2/02/2010, covered with an absorbent cover dressing and changed 

one to two times per week.  Within one week progress toward debridement was noted.



Since ALH has multiple properties that address many 

common, underlying causes of non-healing wounds,  

it was chosen for use on several wound types to  

evaluate its therapeutic effects. 

incluSiOn criteria

The dressing was used on two patients with chronic  

non-healing wounds of varying etiologies, including rheumatoid 

ulceration and a stage IV sacral pressure ulcer.  Patients also 

had multiple co-morbidities.  The presence of one or more 

wounds was causing great pain and discomfort for each 


treatMent PrOtOcOl

Patients were selected to receive ALH dressings for their 

reported wound healing and debriding effects.  ALH 

dressings were applied, covered with an absorbent cover 

dressing, and changed daily, every other day, or more 

frequently if needed for strike–through. 

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




In each case significant wound improvement was noted as 

demonstrated by decreased slough and increased healing.  

ALH dressings were easy to use, economical, effective, 

and well tolerated by each patient, subsequently improving 

life quality.


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.

caSe 2

 - 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.

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




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




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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: 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.



 Dressing Selection Guide 

For Autolytic Debridement and Healing of  

Superficial, Partial and Full Thickness Wounds

Type of Wound







Remove Slough

Promote Granulation

Maintain Moist 



Dry to Light


Light to  



Light to Moderate

Dry to Light





(primary dressing)




















(secondary dressing)















(Teritary dressing)


Bandage or 

Gauze Wrap


Bandage or 

Gauze Wrap




Bandage or 

Gauze Wrap

Conforming Bandage

Conforming Bandage

a guideline for Care




 Dressing Application and Removal


  Wash hands thoroughly 


  Apply gloves 



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


 Paste or 



 Gel for light to moderate exudates,  wounds that are hard to dress, or those that require a wound 

gel or paste; MEDIHONEY


 HCS for dry to moderate exudates that are superficial to partial  thickness wounds; 



 Calcium Alginate dressing for moderate to heavy exudates; MEDIHONEY


 Honeycolloid dressing for 

light to moderate exudates)


   Apply the appropriate MEDIHONEY


 dressing to fit the wound. The MEDIHONEY


  Calcium Alginate and 

Non-adhesive HCS or Honeycolloid can be cut to fit within the wound edges.


   Apply an absorbent cover dressing (XTRASORB


 super absorbent dressings are recommended due to the highly 

osmotic effect of MEDIHONEY






Dressing change: Remove the dressing gently. If the dressing is difficult to remove,  moisten with saline or water. 

Discard the old dressing in a disposal bag.

*  The healthcare provider should be notified if the wound worsens. Report increased redness, pain, swelling, or heat on or around the wound.



Do not use MEDIHONEY





On third degree burns



With patients that have a known sensitivity to honey or any other component parts specific to each dressing (please 

see package insert for more information). 



To control heavy bleeding




If the dressing is not easily removed, soak with sterile saline or water until it is removed without difficulty.



Due to the dressing’s low pH, some patients may notice a slight transient stinging.  If stinging does not stop or 

persists and cannot be managed with an analgesic, remove dressing, cleanse area, and discontinue the use of 






During initial use of the dressing (depending on wound exudate levels, interstitial fluid, and edema surrounding the 

wound), the dressings high osmotic potential may contribute to increased exudate, which could lead to maceration 

if the excess moisture is not managed appropriately. Manage additional moisture by adding an absorptive cover 

dressing and/or adjusting the frequency of dressing change. Protect the peri-wound skin by applying a skin barrier 

protectant to the surrounding skin.



During the healing process it is common for non-viable tissue to be removed from the wound resulting in an initial 

increase in wound size. Although an initial increase in wound size may be attributed to the normal removal of 

non-viable tissue, consult a healthcare professional if the wound continues to grow larger after the first few  

dressing changes.


Derma Sciences, Inc.

214 Carnegie Center, Suite 300

Princeton, NJ 08540

(p) 800 445 7627  (f) 609 514 8554



 Ordering Information

Order Code  


Packaging unit/Case 




0.5 oz tube 

10/box, 4 boxes/case 



1.5 oz tube 

1/box, 12 boxes/case 





2.4" x 2.4"   

10/box, 5 boxes/case 



4.33" x 4.33"  

10/box, 5 boxes/case 



8" x 8"   

5/box, 4 boxes/case 



8" x 12"   

2/box, 5 boxes/case 


Fenestrated - Non-adhesive


1.8" x 1.8"   

10/box, 5 boxes/case 




2.8" x 2.8"  

10/box, 5 boxes/case 



(4.3" x 4.3" with adhesive border)


4 ½" x 4 ½"  

10/box, 5 boxes/case 



(6" x 6" with adhesive border)

Calcium Alginate





" x 12"   

5/box, 4 boxes/case  



2" x 2"   

10/box, 10 boxes/case  



4" x 5"  

10/box, 5 boxes/case 






2" x 2"  

10/box, 10 boxes/case  



4" x 5"  

10/box, 5 boxes/case 




2" x 2"  

10/box, 10 boxes/case 



(3 ½" x 3 ½" with adhesive border) 


4 ½" x 4 ½"     

10/box, 5 boxes/case 



(6" x 6" with adhesive border)



0.5 oz tube  

10/box, 4 boxes/case 



1.5 oz tube 

1/box, 12 boxes/case 



3.5 oz tube 

1/box, 12 boxes/case 


*Refer to for the most current HCPCS coding of MEDIHONEY


 surgical dressings. 



 with our super absorbent cover dressing, XTRASORB


.  It’s osmotic gradient pulls exudate to  

the back of the dressing and converts it into a gel, locking it away - even under compression!

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