TheimpactofMEDIHONEYon

DeepPartialThicknessBurns

Presenter:ArielM.Aballay,MD,FACS
MedicalDirector
TheWestPennBurnCenter

Access this presentation and more information on MEDIHONEY products at www.dermasciences.com

 Agenda

MyClinicalPractice
WhyMEDIHONEY?Whatcanitdo?
AReviewofCases
ImpactonMyPractice
Tips&Pointers
Q&A
MyClinicalFocus
TreatmentofBurn
Injuriesinbothpediatric
andadultpatients
Ourgoalistoheal
woundsintheshortest
periodoftime
Limitfunctional
consequenceswhile
optimizingcosmetic
outcomes
 MEDIHONEY
Whatisit?Whatcanitdo?

Derivedfromthepollenandnectarofthe
Leptospermum speciesofplantinNewZealand
Uniqueamonghoney effectivenessismaintained
eveninthepresenceofwoundfluid
Supportedbyover160piecesofevidence,including
RandomizedControlledTrials,PeerReviewed
articlesandposters,demonstratingefficacyinthe
managementofwoundsandburns.1
Twokeymechanismsofactioncreateanoptimal
environmenttopromotetheremovalofdevitalized
tissueandhealing HighOsmolarityandLowpH

1.MEDIHONEY Reference List. Derma Sciences..

 HighOsmolarity

MEDIHONEYproducesanOsmoticEffectpullingfluidfromdeeper
tissuetothewoundsurface

Workswiththebodysnaturalprocessestobathethewoundbed
promotingtheremovalofdevitalizedtissue2,3

2. Acton C, Dunwoody G. The use of medical grade honey in clinical practice. British J Nursing 2008;17(20): S38-S44.
3. Chaiken, N. Pressure ulceration and the use of Active Leptospermum honey for debridement and healing. Ostomy Wound Management 2010;56(5), 12-14.
 LowpH
0
Woundhealingfavorsan
1

Woundhealing
2
acidicenvironment
3
4 MEDIHONEY
5 pH3.54.5
6
7
Neutral
Woundbreakdown

8
9
10
11
12
13
14

ThelowpHofMEDIHONEY (3.54.5)helpstolowerthepHwithinthewound
environment45,whichhasbeenshowntohavewoundhealingbenefits.6

4.GethinG.InfluenceofManukahoneyonsurfacepH,MMP2,MMP9andwoundsizeofchronicwounds.EuropeanWoundManagementAssociationConference,Lisbon,Portugal,May2008.
5.MilneSD,ConnollyP.TheinfluenceofdifferentdressingsonthepHofthewoundenvironment.JWoundCare.2014Feb;23(2):534,567.
6.Leveen H,FalkG,Borek B,DiazC,Lynfield Y,Wynkoop B,Mabunda GAetal.Chemicalacidificationofwounds.Anadjuvanttohealingandtheunfavourable actionofalkalinityandammonia.
AnnalsofSurgery.1973.178(6):74550.
DifferentConfigurationstoassistWoundBed
Preparation

MEDIHONEYPaste MEDIHONEYGel

MEDIHONEY MEDIHONEY

MEDIHONEY
HCS CalciumAlginate Honeycolloid
Background&CaseReview
 BACKGROUND
Early excision and autologous grafting remains as the gold
standard for third degree burns and deep partial thickness burns,
which are unlikely to heal in 3 weeks7,8
However, in clinical practice this approach may not be ideal for:
Frail, elderly patients
Patients with significant comorbidities in whom anesthesia may not
be desirable
Relatively small burns
Certain areas of the body (such as the face, scalp or genitalia)
Patientsthatdeclinesurgery
Inthesecases,providinganenvironmentthatwouldhasten
debridementandremovalofdevitalizedtissuewouldfacilitate
healingandwoundclosure
7.Janzekovic Z.Anewconceptintheearlyexcisionandimmediategraftingofburns.JTrauma970;10:11038.
8.Engrav LH,Heimbach DM,RuesJL,etal.Earlyexcisionandgraftingvsnonoperative treatmentofburnsofindeterminatedepth:arandomized
prospectivestudy.JTrauma1983;23:10014.
 BACKGROUND
OnestudycomparedtheeffectivenessofahoneydressingtoSSD
onwoundhealinginpatientswithfirstandseconddegreeburns.
Patientstreatedwithhoneydressingshadasignificantlyshorter
durationofhealingcomparedtopatientstreatedwithSSD9
These studies provide evidence that honey may be an effective
treatment option for partial thickness burns

There are no studies exploring the applicability of these findings to

burn injured patients in the United States

This Case Review explores examples of our clinical experience with

MEDIHONEY in the treatment of burn patients since 2013, which
has prompted our initiation of an RCT on this product

9. Malik,K.I.,Malik,M.N.,&Aslam,A.Honeycomparedwithsilversulphadiazine inthetreatmentofsuperficialpartialthicknessburns.InternationalWound
Journal,2010;7(5),413417.
Case1 DeepPartialThicknessBurntoForehead

DAY1

47yearoldfemalepatientwhoexperiencedburns
secondarytohairgroomingproduct
Treatment:MEDIHONEYGelappliedthreetimesaday
Case1 DeepPartialThicknessBurntoForehead

DAY16

Area
Healed Clean,healthy
granulationtissue

Epithelialedge
advancement
Case1 DeepPartialThicknessBurntoForehead

DAY36

Pigmentation
returning
ReEpithilialization
Complete
Case1 DeepPartialThicknessBurntoForehead

Summary

Woundclosure,hairfollicleregrown,pigmentationreturning
after7weeksofMEDIHONEY Geltreatment
Nohypertrophicscarring
Case2 DeeppartialthicknessburnstoFace

Day1

Patientattemptedtolightacigarettewhileonoxygen
Patientalsoexperiencedburnstoleftarmwhenclothescaughtonfire
ORprocedure Ultrasonicdebridementperformedonface
MEDIHONEY Gelinitiatedaftersurgery dailychanges
Case2 DeeppartialthicknessburnstoFace

Day3:Remainingescharisbeing Day4:Asescharissoftened,itiseasily
softenedandliquefiedbythe removed,revealingadvancementin
MEDIHONEY healthytissueformation
Case2 DeeppartialthicknessburnstoFace

Day5:woundcontinuesto Day11:Noseishealed;pinkhealthy
improve skinamongremainingdevitalizedtissue.
ContinuedGeltocompletehealing.
Case2 DeeppartialthicknessburnstoFace

Summary

Postultrasounddebridement,MEDIHONEYGel
promotedcontinuousremovalofdevitalizedtissue
andrapidhealinginlessthan2weeks.
Case3 DeepPartialThicknessBurnimpactinghairline

Deepest area of injury

Day 1

54yearoldfemale
Deepburnstoforehead/facesecondarytoflame
burnscausedwhenhaircaughtfire
Surgerywouldjeopardizefollicleregrowthand
returnofnormalhairline.
Case3 DeepPartialThicknessBurntoForehead

Week3 Week5 Week7

DailyapplicationofMEDIHONEY Gel
Woundhealing,follicleregrowthclosingintoward
deepestpartofburn
Case3 DeepPartialThicknessBurntoForehead

Summary

Lessthan2months,woundhealingevenatdeepestareaofinjury
Patientwillretainnormalhairline
Woundcontinuedtocompletelyfillinasobservedinfurther
clinicalfollowup however,noimagetaken
Case4 StageIVLungCancerPatientwithcontactburns

Day 1

82yearoldmalewithburnssecondarytoheatingpad
Notasurgicalcandidate
MEDIHONEY Gelapplieddailyandcoveredwithnonadherent
dressing
Case4 StageIVLungCancerPatientwithcontactburns

Day 21 (3 weeks)

Significantareaofwoundis
closed.
Smallareas continued Day 42 (nearly 6
woundedgeadvancement weeks)
Woundclosure
Case5 DeepBurnsinImmunosuppressedCrohnsPatient

Initial
Presentation
3WeeksPost
Burn

72yearoldfemalewithCrohns,CRF,shortbowelsyndrome
CurrentlyonTPN,COPDandhighdoseprednisone
Burnscausedbyheatingpadtolefthip
Patientreferredtoclinic3weeksafterinjury
Areacoveredwith95%yellowslough
InitiatedMEDIHONEY Gelandnonadherentdressings
Case5 DeepBurnsinImmunosuppressedCrohnsPatient

Day10after
initiationof
treatment

Sloughgreatlyreduced
Newgranulationtissueandwoundedge
advancementobserved
Case4 DeepBurnsinImmunosuppressedCrohnsPatient

Day25(Wk 3afterinitialtreatment) Day65(Wk 9afterinitialtreatment)

Increaseingranulationtissue Continuousprogressaswound
edgescontinuetoadvancetoclose
thisinjury
Case5 DeepBurnsinImmunosuppressedCrohnsPatient

Day75
(Month3
afterinitial
treatment)

WoundclosurewithMEDIHONEYalone
Nocomplicationsexperiencedbyimmunocompromisedpatient
Nootherinterventionorantibioticrequired
Case5 DeepBurnsinImmunosuppressedCrohnsPatient

Summary

Completeepithelializationwithoutsurgicalinterventionor
complicationsinpatientoncorticosteroidsin3months
Nohypertrophicscarring
Case6 DeepPartialThicknessBurntoHand

Day4 Day19
47yearoldfemalewithburnstorighthandcausedbyhotgrease
Superficialanddeeppartialthicknessburns
DailyMEDIHONEYGelapplicationsforcompletehealing
inlessthan3weeks.
Case7 DeepPartialThicknessBurninPediatricPatient

Day1

Day11
2yearoldmalewithburnscausedbycurlingiron
DailyMEDIHONEYGelapplications,coveredwith
nonadheringdressing
Rapidhealinginlessthan2weeks
ImpactofMEDIHONEYtoPractice
EffectiveinterventionforDeepPartial
thicknessburns
Idealpatients:
Elderly,children,malnourished,cancer
Burnstoface
Palmsofthehand,plantaraspectoffeet
Accessible Patientaccess
andaffordability
 TIPS&Pointers
MEDIHONEYGelcontainsgellingagentsmakingitmore
stableatbodystemperaturethanPaste
Pasteismorefluidwithnogellingagents;usefulforburns
affectingmouthandmaybeaccidentallyswallowed
Acoverdressingwillkeepareamoist/preventtheGelproduct
fromdryingout.Ifunabletocoverarea(i.e face),product
needstobereappliedevery6hours.
Forwoundswithsmallamountofdrainage,theMEDIHONEY
HCSdressingisveryeffective,comfortableandnocover
dressingneeded

Gel HCS Paste

 Questions?
Presenter:ArielM.Aballay,MD,FACS
MedicalDirector
TheWestPennBurnCenter

Access this presentation and more information on MEDIHONEY products at www.dermasciences.com