Honey and Wound Surface Elastic Compression Improves Healing of Refractory Venous Leg Ulcers: enhanced control of pain and bioburden control are advantages

Problem

The cellular mechanisms by which impaired venous circulation creates inflammation that leads to  venous leg ulcers (VLUs) are poorly understood and elastic compression therapy  therapy  remains an art, not a  science. ¹ In general refractory VLUs, present>12 weeks, result from either ineffective elastic compression or inadequate bioburden debridement. Large superficial inflamed VLUs have intact skin nociceptive nerve endings and can be exquisitely painful. Pain is the enemy of adequate elastic compression and  effective debridement. ²

Fuzzy wale elastic compression textile compresses just 20% of the skin surface, and represents a change in the compression therapy paradigm. Noncompressed subcutaneous fat between wales enhances lymphatic run off and significantly improves patient comfort³

Manuka honey* is changing the paradigm for VLU therapy. Recently discovered therapeutic  mechanisms of honey therapy include,  down-regulation of skin nocioceptive receptor activity to minimize ulcer pain, ⁴ chemical debridement of necrotic eschar, ⁵ quenching of free radical oxygen species which cause inflammation , ^6,7 and inhibiting biofilm bacteria. ^8,9

This first human use case report asks two questions.  Does Manuka honey* decrease ulcer pain during elastic wale compression**? Is honey synergistic with elastic compression to improve ulcer healing?  

Methods

Three refractory VLU patients were treated with honey gel or honey alginate dressings (*) on top of fuzzy longitudinal wale elastic compression stockinet (**) as layer one of a three layer dressing.

Results

Photos document complete healing of all wounds. Control of ulcer pain during elastic compression is discussed.

Conclusion

Manuka honey appears synergistic with fuzzy wale elastic compression to heal refractory venous leg ulcers. Honey therapy may to decrease ulcer pain during elastic compression.