The effectiveness of Leptospermum (Manuka) Honey in necrotic tissue associated with challenging wounds when sharp debridement is not an option

Background:  In our busy wound center, we see a diverse array of wounds that need debridement.   Often the patient is not a candidate for sharp debridement. Since the prescription papain/urea based products are no longer on the market, we have been in the search of debridement products that are clinically effective, cost efficient and are easy to use. There has been emerging interest in the use of honey in promoting autolytic debridement.  The purpose of these case studies was to evaluate two types of Manuka honey based products, one a gel, the other a contact layer with perforations.  The honey in both is 100% Manuka honey from New Zealand.

Methods: 10 patients were sequentially identified whose wounds definitely needed debridement, but who could not be debrided sharply down to viable tissue, for a number of reasons.  Honey gel* was applied to wounds with minimal to moderate drainage while the contact layer** was typically used for wounds with moderate to heavy drainage.  In both cases, appropriate secondary dressings were used.  Wound assessment including size measurements, photography, and the percentage determination of necrotic tissue versus viable (granulation and epithelial) tissue were made at each dressing change.

 Results and Conclusion:  Wound dimensions generally decreased, though in some cases, as not uncommon with autolytic debridement, the wound initially increased before reducing in size.  The honey dressings reduced the extent of necrotic tissue, while also maintaining a moist wound environment.   The differing rates of autolytic debridement were influenced by the age and type of wound along with the patient’s general medical condition.  Given the diverse nature of these wounds, it is apparent that the use of Manuka honey dressings provide a valuable option to sharp debridement that is welcome following the removal of  previously accessible and effective products such as papain/urea.