Why do some cavity wounds treated with honey or sugar paste heal without scarring?

In vivo and in vitro evaluation of chitosan-modified bioactive glass paste for wound healing

In this work, the role of chitosan (CS) in improving the properties of bioactive glass (BG) paste for wound healing was studied. Based on in vitro evaluation, it was found that the addition of CS neutralizes the pH value from 11.0 to 7.5, which did not lead to decreasing the bioactivity of BG paste in vitro. The rheological properties showed that the composite paste had higher bio-adhesion and better affinity with the skin surface than either CS or the BG paste. The antibacterial property evaluation showed that the composite paste had stronger antibacterial activity than either CS or BG paste and promoted the proliferation of HUVECs (human umbilical vein endothelial cells) and HaCat (human immortalized keratinocyte cells). Comparatively, the effect of promoting the proliferation of HUVECs is more significant than that of HaCat. The burn-wound model of rat was developed for evaluating in vivo activity, and the addition of CS effectively promoted wound healing without obvious inflammation according to the IL-1β and IL-6 staining. This novel paste is expected to provide a promising alternative for wound healing.

Wound healing efficacy of Jamun honey in diabetic mice model through reepithelialization, collagen deposition and angiogenesis

Diabetic patients are frequently afflicted with impaired wound healing where linear progression of molecular and cellular events compromised. Despite of meaningful progress in diabetic treatment, management of diabetic chronic wounds is still challenging. Jamun (Syzygium cumini) honey may be a promising candidate for diabetic wound healing and need to explore in detail. So present study was designed to evaluate the efficacy of Jamun honey (JH) for diabetic wound healing in in vitro wound (primary fibroblasts) model and in in vivo of diabetic mice (Streptozotocin induced) model. The fibroblast cell model was studied for migratory behaviour and myofibrolasts infiltration under honey interventions via scratch/migration assay, immuno-cytochemistry and western blot. We applied FDA approved Manuka honey (MH) as positive control and JH as test honey to evaluate wound re-epithelialization, sub-epithelial connective tissue modification and angiogenesis via histo-pathological and immuno-histochemical analysis. JH (0.1% v/v) dilution has notably improved wound closure, migration with concomitant α-SMA expressions in vitro. Topical application of JH in diabetic mice model showed significant (*p ≤ 0.05) wound closure, reepithelialization, collagen deposition (I/III) and balanced the myofibroblasts formation. It also modulated vital angiogenic markers (viz HIF-1α, VEGF, VEGF R-II) significantly (*p ≤ 0.05). All these observations depicted that JH promotes sequential stages of wound healing in diabetic mice model. The results of the present study established Jamun honey as good as Manuka honey considering wound closure, re-epithelialization, collagen deposition and pro-angiogenic potential.

Effect of Topical Honey on Mandibular Bone Defect Healing in Rats

AIM

In medicine, honey is known for its various biological or pharmacological effects, from wound dressing to anticancero-genic and from anti-inflammatory to antibacterial activities. The aim of the current study was to evaluate the effect of honey on healing of mandibular bone defects in a rat model.

MATERIALS AND METHODS

This animal study was performed on 24 wild-type Wistar rats. Following shaving, disinfection, and extraoral incision, a 2 × 2 mm defect was created at mandibular angle. In the experimental group, the defect was filled with sterile honey, while it was left unfilled in the control group. The rats were sacrificed after 2 and 4 weeks and defects were assessed histologically. The results were compared using Mann-Whitney U-test (α = 0.05).

RESULTS

After 2 weeks, five samples of the experimental group were in mineralization phase, while all samples of the control group were in the vascularization phase (p = 0.015). After 4 weeks, the defects were filled in four samples of the experimental group, while all samples of the control group were in the mineralization stage (p = 0.002). Histomorphometric assessment revealed that the mean new bone formation in the experimental group was significantly more than the control group, both after 2 and 4 weeks (p = 0.041).

CONCLUSION

The results showed that honey could accentuate bone healing of mandibular small defects in rats.

CLINICAL SIGNIFICANCE

Honey might have potential in repair of human alveolar bone defects.

Skin Wound Healing: Refractory Wounds and Novel Solutions

This overview of the current state of skin wound healing includes in vitro and in vivo approaches along with some recent clinical trials. From an introduction to wound healing, to tissue engineering as applied to the skin, we cover the basis for the current wound care techniques as well as novel and promising approaches. Special emphasis is given to refractory wounds which include wounds in diabetic patients. Natural compounds have been ever present in wound healing, and so we devote a section to highlighting current attempts to understand their mechanisms and to use them in novel ways.

Application of Hyperosmotic Nanoemulsions in Wound Healing: Partial Thickness Injury Model in Swine

Objective: In this work, we introduce a novel hyperosmotic nanoemulsion (HNE) topical agent for use in wound healing. These topical emulsion complexes combine a lipophilic thymol nanoemulsion with a hyperosmotic saccharide matrix. This combination has been previously shown to possess synergistic antimicrobial activity against a host of common and drug-resistant pathogens in vitro. Approach: In this study, we present additional data to assess the safety and efficacy of these emulsions in a partial thickness injury model in swine. Ten wounds sized 2 × 3.5 cm were created in 18 pigs using an electrodermatome set at a depth of 0.76 mm. The wounds were subsequently contaminated with a cocktail of Escherichia coli, Staphylococcus aureus, Enterococcus faecalis, and Candida albicans at 5 × 10⁷ total colony forming unit per wound. Treatments were subdivided in the control group and emulsion concentrations at 0.0%, 0.01%, 0.03%, and 0.063% thymol content. Longitudinal metrics for wound healing included rate of reepithelialization, wound bed color measurements, amount of wound exudate, wound swab culture data, and histological examination at 4, 7, and 14 days. The cosmetics of the healed wound were obtained at day 14 with three-dimensional photogrammetry. Results: Experimental results showed that HNE reduced the wound level bacteria count by ∼0.5-1 log versus controls after 24 h. The amount of pathogen reduction was weakly correlated to the concentration of the emulsion. In addition, all HNE groups maintained a moist wound environment and showed increased fibrin formation and improved hemostatic response. Innovation: No significant difference in the rate of reepithelialization or wound closure was found between treatment concentrations and control groups. HNE treatment did not demonstrate any adverse host tissue response. Conclusion: These results suggest HNE may be a candidate for reducing wound bacterial counts without compromising reepithelialization.

Synthesis of a semi-interpenetrating polymer network as a bioactive curcumin film

This study focused on the synthesis and characterization of a natural polymeric system employing the interpenetrating polymer network (IPN) comprising curcumin as a bioactive. Biopolymers and actives such as chitosan, hypromellose, citric acid, genipin, and curcumin were used to develop an effective, biodegradable, and biocompatible film employed therapeutically as a wound healing platform. The semi-IPN films were investigated for their physicochemical, physicomechanical, and biological properties by quantification by FTIR, DSC, and Young's modulus. Following characterization, an optimum candidate formulation was produced whereby further in vitro and ex vivo studies were performed. Results revealed a burst release occurring at the first hour with 1.1 mg bioactive released when in contact with the dissolution medium and 2.23 mg due to bioactive permeation through the skin, thus suggesting that the lipophilic nature of skin greatly impacted the bioactive release rate. Furthermore, chemical and mechanical characterization and tensile strength analysis revealed that the degree of crosslinking and concentration of polymeric material used significantly influenced the properties of the film.

Honey: a potential therapeutic agent for managing diabetic wounds

Diabetic wounds are unlike typical wounds in that they are slower to heal, making treatment with conventional topical medications an uphill process. Among several different alternative therapies, honey is an effective choice because it provides comparatively rapid wound healing. Although honey has been used as an alternative medicine for wound healing since ancient times, the application of honey to diabetic wounds has only recently been revived. Because honey has some unique natural features as a wound healer, it works even more effectively on diabetic wounds than on normal wounds. In addition, honey is known as an "all in one" remedy for diabetic wound healing because it can combat many microorganisms that are involved in the wound process and because it possesses antioxidant activity and controls inflammation. In this review, the potential role of honey's antibacterial activity on diabetic wound-related microorganisms and honey's clinical effectiveness in treating diabetic wounds based on the most recent studies is described. Additionally, ways in which honey can be used as a safer, faster, and effective healing agent for diabetic wounds in comparison with other synthetic medications in terms of microbial resistance and treatment costs are also described to support its traditional claims.

The role of honey in healing of bedsores in cancer patients

Background:

Honey was used to treat infected wounds as long as 2000 years before bacteria were discovered. It has been reported to have inhibitory action to around 50 species of bacteria and fungi (aspergillus, penicillium). Usually, Metronidazole powder is used in our palliative clinic for wound healing due to low cost & effectivity. Honey is cheap, easily available ingredient with high astringent activity.

Objective:

Objectives of the study were to find out the effectiveness of Honey in terms of rate of wound healing & pain control in bedsores of cancer patients.

Materials and Methods:

40 cancer patients with bedsore wounds were randomly assigned (1:1 ratio i.e. 20 in each arm) for Study Arm (Honey plus Metronidazole powder) and Control Arm (only Metronidazole powder), attending Palliative clinic of our department in between July 2010 to September 2011.Washing of the wound with normal saline done daily before application of above medicaments. Change of posture & soft bed were encouraged in both groups. A pre designed interview proforma, standardised Bates Jensen Wound Assessment Tool and Visual Analogue Pain assessment scale were used to collect and assess data.

Results:

There was significant difference in wound healing status (F value = 6.523; Critical Difference =14.03, P>0.05) from day 10 and pain reduction also (F value = 6.638 and Critical Difference = 1.667, P>0.05) from day 7 in study arm.

Conclusion:

Application of honey dressing provides a better wound healing, rapid pain relief in cancer patients with bedsores in palliative settings.

Histopathological and clinical evaluation of Kombucha tea and Nitrofurazone on cutaneous full-thickness wounds healing in rats: an experimental study

Background

Kombucha, a fermented tea (KT) is claimed to possess many beneficial properties. The aim of this study was to evaluate clinical and histopathological alterations of Kombucha tea and Nitrofurazone on cutaneous full-thickness wounds healing in rat.

Methods

In present study 24 Wister -albino rats weighing 150–200 g were selected and divided to two treatment groups as Nitrofurazone ointment (0.2%) and Kombucha tea. Subsequently, the anesthesia was exerted by Ketamin hydrochloride 10% (40 mg/kg) and Xylasine (2 mg/kg) through intra muscular (IM) route. Furthermore, upon preparation of dorsal region of the animal for surgery, a piece of full-thickness skin removed (2 × 2 cm). In order to comparing wounds healing clinically and histologically, once every four days from the commencement, the wounds were photographed and the healed surface was measured by Scion image software.

Result

The clinical findings indicated that the Kombucha fungus resulted in precipitating healing than Nitrofurazone; however, it was not significant (p > 0.05). In order to pathological comparing of wound healing process, several wound biopsies were taken on 4, 8, 12, 16 and 20^th days. Additionally, the histopathological results demonstrated that there was inflammation in Nitrofurazone group through twelveth day, somehow the epithelium was formed and abundant vessels were visible. Although on 16^th day and the previous days the healing condition of Kombucha fungus was considered as minimal rate, revealing it is similar to Nitrofurazone group on 20^th day.

Conclusions

To wrap up. These observations suggest that the Kombucha fungus healing quality was rapid from 12^th day to the end of the research, whereas no significant difference was observed.

Virtual slide

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1107407136102196

Antibacterial effect of Manuka honey on Clostridium difficile

BACKGROUND

Manuka honey originates from the manuka tree (Leptospermum scoparium) and its antimicrobial effect has been attributed to a property referred to as Unique Manuka Factor that is absent in other types of honey. Antibacterial activity of Manuka honey has been documented for several bacterial pathogens, however there is no information on Clostridium difficile, an important nosocomial pathogen. In this study we investigated susceptibility of C. difficile to Manuka honey and whether the activity is bactericidal or bacteriostatic.

METHODS

Three C. difficile strains were subjected to the broth dilution method to determine minimum inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC) for Manuka honey. The agar well diffusion method was also used to investigate sensitivity of the C. difficile strains to Manuka honey.

RESULTS

The MIC values of the three C. difficile strains were the same (6.25% v/v). Similarly, MBC values of the three C. difficile strains were the same (6.25% v/v). The activity of Manuka honey against all three C. difficile strains was bactericidal. A dose-response relationship was observed between the concentrations of Manuka honey and zones of inhibition formed by the C. difficile strains, in which increasing concentrations of Manuka honey resulted in increasing size of zone of inhibition formed. Maximum zone of inhibition was observed at 50% (v/v) Manuka honey and the growth inhibition persisted over 7 days.

CONCLUSION

C. difficile is appreciably susceptible to Manuka honey and this may offer an effective way of treating infections caused by the organism.

Effects of honey and sugar dressings on wound healing

OBJECTIVE

To investigate whether there is a difference between the efficacy of honey and sugar as wound dressings.

METHOD

Patients with open or infected wounds were randomised to receive either honey or sugar dressings. Bacterial colonisation, wound size, wound ASEPSIS score and pain were assessed at the start of treatment and at weekly intervals until full healing occurred.

RESULTS

Forty patients were enrolled; 18 received sugar dressings and 22 honey dressings. In the honey group, 55% of patients had positive wound cultures at the start of treatment and 23% at one week, compared with 52% and 39% respectively in the sugar group.The median rate of healing in the first two weeks of treatment was 3.8cm2/week for the honey group and 2.2cm2/week for the sugar group. After three weeks of treatment 86% of patients treated with honey had no pain during dressing changes, compared with 72% treated with sugar.

CONCLUSION

Honey appears to be more effective than sugar in reducing bacterial contamination and promoting wound healing, and slightly less painful than sugar during dressing changes and motion.

Effect of topical honey application along with intralesional injection of glucantime in the treatment of cutaneous leishmaniasis

Background

Leishmaniasis is an endemic disease in Iran. Although many treatments have been suggested for this disease, there hasn't been an effective and safe treatment yet. Regarding the healing effect of honey in the chronic ulcers and its reported therapeutic effect in cutaneous leishmaniasis, we performed a study to better evaluate the efficacy of honey in cutaneous leishmaniasis and its final scar.

Methods

In a prospective clinical trial, 100 patients with confirmed cutaneous leishmaniasis were selected and randomized into 2 groups. Group A were treated with topical honey twice daily along with intralesional injection of glucantime once weekly until complete healing of the ulcer or for maximum of 6 weeks. Group B were treated with intralesional injection of glucantime alone until complete healing of the ulcer or for a maximum of 6 weeks, too. The patients were followed for 4 months. The collected data were analyzed statistically using statistical tests including Chi-square, Mann Whitney and Kaplan – Mayer tests.

Results

In this study, 45 patients that had cutaneous leishmaniasis were treated with intralesional glucantime alone and 45 patients were treated with topical honey and glucantime . Ten patients left out the study. In the glucantime alone treated group, 32 patients (71.1%) had complete cure whereas in the group treated with both glucantime & topical honey, 23 patients (51.1%) achieved complete cure. This difference was significant statistically (p = 0.04).

Conclusion

Further studies to better clarify the efficacy of honey in cutaneous leishmaniasis is needed. We suggest that in another study, the efficacy of honey with standardized level of antibacterial activity is evaluated against cutaneous leishmaniasis.

Inhibition effect of honey on the adherence of Salmonella to intestinal epithelial cells in vitro

The aim of the study was to evaluate the antimicrobial effect and the ability of honey to prevent Salmonella interitidis adhering to intestinal epithelial cells in vitro. Antimicrobial activity was demonstrated. Bacterial adherence was assayed using S. interitidis cells that had been incubated first with honey and then with the intestinal epithelial cells. Results showed that honey at dilutions of up to 1:8 reduced bacterial adherence from 25.6+/-6.5 (control) to 6.7+/-3.3 bacteria per epithelial cell (P<0.001).

Evaluation of a honey-impregnated tulle dressing in primary care

Honey has been used for its healing properties for centuries and has been used to dress wounds with favourable results. The emergence of antibiotic resistance and growing interest in "natural" or "complementary" therapies has led to an interest in honey dressings. Much of the research to date has been related to honey's antibacterial properties. However, the healing properties claimed for honey also include stimulating new tissue growth, moist wound healing, fluid handling and promoting epithelialization. Until recently, honey had not been developed as a wound management product and was not a certified pharmaceutical device. Activon Tulle is a sterile, non-adherent dressing impregnated with Leptospermum scoparium hone. The claimed properties of honey dressings would make this a valuable addition to the dressing currently available in the primary care setting. An evaluation was undertaken involving 20 patients with a variety of wounds. A conclusion is drawn that while further research is needed, medical grade honey does appear to be a valuable addition to the wound management formulary.

Principles of wound management of small mammals: hedgehogs, prairie dogs, and sugar gliders

The management of wounds is a common scenario for the exotic animal practitioner. When presented with such cases, the practitioner must first adhere to the firmly established principles of wound healing, and then modify available treatment modalities to fit the needs of the species at hand. Practicing wound management on exotic patients can be challenging due to their small size, unusual anatomy, difficult behaviors, and tendency for developing secondary stress-related health problems. A review of the stages of wound healing as well as traditional wound management techniques is provided here. This review is followed by a summary of typical wounds encountered in hedgehogs, prairie dogs, and sugar gliders, as well anatomic, physiologic, and behavioral characteristics that should be taken into consideration when managing wounds on such species.

Use of honey as an adjunct in the healing of split-thickness skin graft donor site

BACKGROUND

Different techniques are being used in treatment of split-thickness skin graft donor sites; however, there is not a widely accepted method established for these partial-thickness wounds. It is well known that honey has been very effective in the treatment of various types of wounds, but there is not any information about the usage of honey as split-thickness skin graft donor site dressing in the literature.

OBJECTIVE

To evaluate and compare the effectiveness of honey-impregnated gauzes, hydrocolloid dressings, and as a conventional dressing, saline-soaked gauzes for skin graft donor sites.

METHODS

This is a nonrandomized, prospective, open-label (noncontrolled), side-by-side comparison trial of various options that are available for second-intention healing of donor site for split-thickness skin grafts. Eighty-eight patients who underwent skin grafting were observed using two different groups. In the first group, the donor site was divided into two equal halves, with each half being treated with honey-soaked gauzes and the other half with paraffin gauzes (group 1A), hydrocolloid dressings (group 1B), and saline-soaked gauzes (group 1C) alternatively. In the second group, two separate donor sites were formed, with one of them being treated with honey-impregnated gauzes (groups 2A-C) and the other one treated with either paraffin gauzes (group 2A), hydrocolloid dressings (group 2B), or saline-soaked gauzes (group 2C). The healing time, rate of infection, and sense of pain were evaluated. RESULTS. : In the treatment of split-thickness skin graft donor sites, honey-impregnated gauzes showed faster epithelization time and a low sense of pain than paraffin gauzes and saline-soaked gauzes. There was no significant difference between honey-impregnated gauzes and hydrocolloid dressings with regard to epithelization time and sense of pain.

CONCLUSION

The use of honey-impregnated gauzes is effective, safe, and practical. Honey can be an alternative material for the split-thickness skin graft donor site treatment.