Limb at Risk: Use of Active Leptospermum Honey for the Management of an Infected Foot Wound Complicated by Cellulitis

Problem

A 72 year old diabetic female noted rapid spreading of a reddened area on the dorsal surface of the foot, presented to the hospital and was diagnosed with cellulitis.  Immediate care included sharp debridement and antibiotic therapy.  She was transferred to rehabilitation for continued antibiotic therapy and local wound care.  The wound assessment revealed large amounts of thick slough in the wound bed surrounded by periwound edema, erythema and warmth. 

Rationale

A Multidisciplinary plan of care was developed that included topical wound management with Leptospermum honey, systemic antibiotic therapy, offloading and supportive care by the multidisciplinary team.  Active Leptospermum honey dressings were utilized to debride necrotic tissue, reduce edema, erythema, warmth, and microbial load, and to provide a moist healing environment.

Methods

Active Leptospermum honey was applied to the wound with an absorbent cover dressing. The cover dressing was changed daily.  After debridement, mist ultrasound and negative pressure wound therapy were initiated.  During the final phase of wound healing, active Leptospermum honey was re-initiated to enhance complete re-epithelialization.

Results

The high osmolarity of the Leptospermum honey dressing rapidly liquefied devitalized tissue and decreased periwound edema.  Antimicrobial activity contributed to reducing erythema, and warmth.  Rapid re-epithelial tissue growth was noted.

Conclusion

Active Leptospermum honey dressings are easy to use and very effective for wound bed preparation.  The dressings can be used during all phases of wound healing.  Further studies are indicated.