{ "slug": "does-manuka-honey-help-heal-wounds", "question": "Does manuka honey help wounds heal, including after anorectal surgery?", "shortTitle": "Manuka Honey for Wound Healing", "clinicalQuestion": "In patients with open or surgical wounds, including anorectal wounds such as those after hemorrhoidectomy, anal fistula surgery, or pilonidal sinus excision, does topical application of manuka honey compared with standard wound care improve wound healing time, infection rate, or complete healing at follow-up?", "pico": { "population": "Adults with open surgical or chronic wounds, including anorectal surgical wounds (e.g., post-hemorrhoidectomy, anal fistula, pilonidal sinus)", "intervention": "Topical manuka honey dressing", "comparator": "Standard wound dressing or usual wound care without honey", "outcomes": [ "Time to complete wound healing (days)", "Proportion of wounds fully healed at a defined follow-up (e.g., 4 or 8 weeks)", "Wound infection rate", "Pain score during dressing changes", "Wound size reduction over time", "Adverse reactions to dressing" ] }, "category": "anorectal", "relatedConditions": [ "hemorrhoids", "anal-fissure", "anal-fistula", "pilonidal-sinus-disease" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "No study has tested manuka honey specifically on anorectal surgery wounds like hemorrhoidectomy or fistula surgery, and the one closest trial — on pilonidal sinus wounds — found no real benefit.", "detail": "Of 78 related studies, only a pilonidal sinus wound trial and a pilonidal scoping review relate to anorectal surgery at all, and that trial found healing took about the same time with or without honey. Several other studies, in different wound types, found manuka honey could slow healing or damage tissue rather than help it, including one case where a wound worsened during treatment and a case report of a serious infection concern after topical honey use. Overall certainty is very low because almost all the evidence is indirect, testing other wounds, animals, or lab models.", "studyIds": [ "pmid:36598614", "pmid:26054992", "pmid:38358154", "pmid:37940425", "pmid:32335523", "pmid:32220630", "pmid:29718813", "pmid:27852015", "pmid:25945118" ] }, "strength": { "level": "very-low", "why": "The 78 human studies found measure a related question rather than this one, so they can only be read indirectly.", "override": null }, "direction": { "level": "harm-signal", "why": "6 studies reported harm or tissue damage, including laboratory evidence.", "override": null }, "counts": { "recordsRetrieved": 358, "recordsScreened": 200, "included": 142, "rcts": 24, "systematicReviews": 18, "observational": 2, "participants": 9859, "yearFrom": 2015, "yearTo": 2026, "registeredTrialsWithoutResults": 0 }, "excluded": [], "outcomes": [ { "name": "Time to complete wound healing after anorectal surgery (days)", "status": "no-improvement", "note": "The only trial in this exact setting (pilonidal sinus wounds) found average healing took about 61 days with honey versus 78 days without it, but this difference was not statistically significant.", "studyIds": [ "pmid:36598614" ] }, { "name": "Proportion of wounds fully healed at a defined follow-up", "status": "not-studied", "note": "No identified trial reported what percentage of hemorrhoidectomy, fistula, or pilonidal wounds were completely healed at a set follow-up point like 4 or 8 weeks.", "studyIds": [] }, { "name": "Wound infection rate after anorectal surgery", "status": "not-studied", "note": "No trial in anorectal surgical wounds reported infection rates with manuka honey dressings.", "studyIds": [] }, { "name": "Pain score during dressing changes (anorectal surgery)", "status": "not-studied", "note": "Pain during dressing changes has been measured for honey at other surgical sites, such as the mouth, but not in anorectal surgery wounds.", "studyIds": [] }, { "name": "Wound size reduction over time (anorectal surgery)", "status": "not-studied", "note": "No anorectal surgery trial tracked wound size shrinkage over time with manuka honey.", "studyIds": [] }, { "name": "Adverse reactions or tissue damage from honey dressings", "status": "possible-harm", "note": "Across other wound types, not anorectal surgery, six studies found honey slowed wound closure, damaged skin cells, or coincided with a serious infection concern — a human wound study, a case report where a wound worsened during treatment, a suspected case of wound botulism in an infant, and three animal studies showing impaired healing.", "studyIds": [ "pmid:38358154", "pmid:32335523", "pmid:32220630", "pmid:29718813", "pmid:27852015", "pmid:25945118" ] } ], "benefits": [], "limitations": [ { "text": "Of the studies reviewed, only two looked at a related anorectal-area procedure - pilonidal cyst or sinus surgery wounds - and none specifically studied hemorrhoidectomy or anal fistula surgery wounds.", "studyIds": [ "pmid:36598614", "pmid:26054992" ] }, { "text": "Most studies that found a benefit for honey were done in completely different wounds, such as diabetic foot ulcers, burns, dental extraction sockets, and caesarean section incisions, which cannot be assumed to behave like anal or perianal wounds.", "studyIds": [ "pmid:41928876", "pmid:37164834", "pmid:27027667" ] }, { "text": "Several of the harm signals come from animal models or tissue tested outside the body, not from patients, so how much they apply to human anorectal wounds is unclear.", "studyIds": [ "pmid:29718813", "pmid:27852015", "pmid:25945118", "pmid:37940425" ] }, { "text": "The one directly relevant trial, in pilonidal wounds, was small and from a single center, so it may simply have been too small to detect a true difference either way.", "studyIds": [ "pmid:36598614" ] } ], "risks": [ { "text": "A case report describes an infant who developed sudden-onset paralysis, suspected to be wound botulism, days after topical medical-grade honey was used on a surgical wound; the diagnosis was not fully confirmed, but it raises a safety concern for open or deep wounds.", "studyIds": [ "pmid:32220630" ], "severity": "serious" }, { "text": "In one case report, a complex wound got worse during five weeks of manuka honey treatment and only started improving after switching to a different dressing.", "studyIds": [ "pmid:32335523" ], "severity": "serious" }, { "text": "Testing on human burn tissue outside the body found that a manuka honey product (Medihoney) completely stopped new skin cells from growing back and multiplying, and had a weaker antibacterial effect than a different honey blend (L-Mesitran Soft); this study did not report how it compared with silver-based treatments on skin regrowth.", "studyIds": [ "pmid:37940425" ], "severity": "minor" }, { "text": "A study in people needing dead tissue removed from wounds found honey took much longer than another plant-based dressing to clear dead tissue and infection.", "studyIds": [ "pmid:38358154" ], "severity": "minor" }, { "text": "Three separate animal studies found honey-treated wounds healed more slowly, with weaker tissue repair, than wounds treated without honey.", "studyIds": [ "pmid:29718813", "pmid:27852015", "pmid:25945118" ], "severity": "minor" } ], "whyPeopleTryIt": [ { "text": "It's marketed as 'natural' and 'medical-grade,' which can feel safer or gentler than manufactured treatments." }, { "text": "Manuka honey has a reputation for killing bacteria, so people hope it will prevent infection in a wound that's hard to keep clean, like one after anorectal surgery." }, { "text": "Online stories and product packaging often describe quick healing, which can feel more convincing than reading a study." }, { "text": "People want to avoid antibiotics or harsher chemical dressings." }, { "text": "Some clinicians suggest it as a seemingly low-risk option when standard dressings haven't worked." } ], "keyStudies": [ "pmid:36598614", "pmid:26054992", "pmid:37940425", "pmid:27852015", "pmid:29718813", "pmid:25945118", "pmid:32220630", "pmid:38358154" ], "studies": [ { "id": "pmid:42724030", "pmid": "42724030", "doi": "10.52225/narra.v6i2.3121", "nctId": null, "pmcid": "PMC13558871", "title": "Development and preclinical evaluation of an Aceh kelulut honey-based hydrocolloid dressing for wound healing", "firstAuthor": "Putra", "multipleAuthors": true, "journal": "Narra J", "year": 2026, "design": "animal", "n": 27, "nField": "reported", "population": "mice with surgically created skin wounds", "intervention": "Aceh kelulut honey-based hydrocolloid dressing", "comparator": "pure Aceh kelulut honey and saline (0.9% NaCl) control", "primaryOutcome": "wound healing measured by wound closure size and tissue healing markers (inflammation, myofibroblasts, collagen, epithelialization)", "result": "faster wound closure and improved inflammation control, wound contraction, and collagen deposition, but lower epithelialization in early phase compared to other groups", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a small animal study on mice, not humans, so it cannot directly tell us about human wound healing, especially after surgery.", "directness": "indirect", "limitations": "Small sample size (27 mice), animal model only, not anorectal surgery wounds, and epithelialization was worse in the treatment group early on.", "followUp": "14 days", "plainFinding": "Faster healing but slower skin regrowth.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42724030/", "sourceText": "Honey has long been used in wound care because of its antibacterial and anti-inflammatory properties, while hydrocolloid dressings provide a moist and protective environment that supports tissue repair. This study aimed to evaluate the macroscopic and microscopic effects of an Aceh kelulut honey-based hydrocolloid dressing on wound healing in mice. Twenty-seven healthy male mice (Mus musculus) were assigned to three groups: control treated with 0.9% NaCl, pure Aceh kelulut honey (KH), and Aceh kelulut honey-based hydrocolloid (KHHC). Two full-thickness excisional wounds, each 4 mm in diameter, were created on the dorsal skin of each mouse. Wound diameter was measured daily for 14 days. Histopathological evaluation was performed on days 3, 7, and 14 to assess neutrophil and macrophage counts, epithelialization ratio, myofibroblast ratio, and collagen fiber density. The KHHC group showed faster macroscopic wound closure than the KH and control groups. Significant differences were observed among groups in neutrophil count, macrophage count, epithelialization ratio, myofibroblast ratio, and collagen fiber density. KHHC reduced inflammatory cell infiltration, increased myofibroblast ratio, and enhanced collagen fiber density, suggesting accelerated wound contraction and tissue remodeling. However, epithelialization was lower in the KHHC group during the early healing phase. These findings indicate that Aceh kelulut honey- based hydrocolloid dressing may improve several key aspects of wound healing, particularly inflammation control, wound contraction, and collagen deposition. Further studies are required to optimize the formulation and clarify its effect on reepithelialization.", "provenance": [ { "field": "n", "quote": "Twenty-seven healthy male mice (Mus musculus) were assigned to three groups" }, { "field": "population", "quote": "Two full-thickness excisional wounds, each 4 mm in diameter, were created on the dorsal skin of each mouse." }, { "field": "intervention", "quote": "Aceh kelulut honey-based hydrocolloid (KHHC)" }, { "field": "comparator", "quote": "control treated with 0.9% NaCl, pure Aceh kelulut honey (KH)" }, { "field": "primaryOutcome", "quote": "Wound diameter was measured daily for 14 days. Histopathological evaluation was performed on days 3, 7, and 14 to assess neutrophil and macrophage counts, epithelialization ratio, myofibroblast ratio, and collagen fiber density." }, { "field": "result", "quote": "The KHHC group showed faster macroscopic wound closure than the KH and control groups." }, { "field": "result", "quote": "However, epithelialization was lower in the KHHC group during the early healing phase." } ] }, { "id": "pmid:42641744", "pmid": "42641744", "doi": "10.1016/j.nano.2026.103013", "nctId": null, "pmcid": null, "title": "Formulation, nanoencapsulation and characterisation of mānuka oil and β-triketones for biomedical applications", "firstAuthor": "Alhamdani", "multipleAuthors": true, "journal": "Nanomedicine", "year": 2026, "design": "lab", "n": null, "nField": "not-reported", "population": "not applicable (laboratory study, no patients)", "intervention": "manuka oil and β-triketone nanoparticles encapsulated in chitosan", "comparator": "", "primaryOutcome": "nanoparticle characteristics, antimicrobial effect, and cell toxicity", "result": "Nanoparticles were successfully made, killed bacteria at certain concentrations, and did not harm cells in testing", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a laboratory study of nanoparticle formulation with no patients or wounds tested, so it cannot show whether this helps wound healing in people.", "directness": "indirect", "limitations": "Study is in-vitro formulation and antimicrobial/biocompatibility testing only; no human or animal wound healing data reported.", "followUp": "", "plainFinding": "Lab-made nanoparticles killed bacteria, not tested on wounds.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42641744/", "sourceText": "Mānuka oil (MO) is derived from mānuka shrubs in New Zealand (NZ) and presents antimicrobial properties that may help combat antibiotic resistance. However, applications of MO are limited due to volatility, sensitivity to light and heat, and the complexity of controlled administration. We used ionic gelation to encapsulate MO and its derivative β-triketones (TK) within chitosan nanocarriers. Nanoparticles were characterised for morphology, chemical composition, encapsulation efficiency and release profile. Antimicrobial properties and biocompatibility were evaluated. Nanoparticles loaded with MO or TK were successfully synthesised with an average size of 331.5 nm (PDI 0.431) and 333.5 nm (PDI 0.503), respectively. Formulations showed positive zeta potentials, stability, high yield (1.5-1.8 g), as well as oil release over 24 h. Bactericidal effect was achieved at concentrations of 3.125-25.000 mg/ml, with no cytotoxic effect. This study has demonstrated the formulation of MO and TK nanoparticles for potential applications in wound dressing, protective coating and targeted drug delivery.", "provenance": [ { "field": "intervention", "quote": "We used ionic gelation to encapsulate MO and its derivative β-triketones (TK) within chitosan nanocarriers." }, { "field": "primaryOutcome", "quote": "Nanoparticles were characterised for morphology, chemical composition, encapsulation efficiency and release profile. Antimicrobial properties and biocompatibility were evaluated." }, { "field": "result", "quote": "Bactericidal effect was achieved at concentrations of 3.125-25.000 mg/ml, with no cytotoxic effect." }, { "field": "population", "quote": "Mānuka oil (MO) is derived from mānuka shrubs in New Zealand (NZ) and presents antimicrobial properties" } ] }, { "id": "pmid:42544260", "pmid": "42544260", "doi": "10.1093/burnst/tkag035", "nctId": null, "pmcid": "PMC13429051", "title": "Bio-enhanced silk fibroin-based scaffolds for chronic diabetic foot ulcers", "firstAuthor": "Lopez", "multipleAuthors": true, "journal": "Burns Trauma", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "patients with chronic diabetic foot ulcers", "intervention": "silk fibroin-based wound scaffolds enhanced with bio-additives (manuka honey mentioned only as part of one approved product)", "comparator": "standard diabetic wound care treatments", "primaryOutcome": "wound healing and tissue regeneration in chronic diabetic foot ulcers", "result": "review states a collagen-Manuka honey-hydroxyapatite patch has shown improved outcomes, but gives no specific data, population details, or comparison figures", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review focused on silk fibroin scaffolds that mentions a manuka honey product only in passing, without describing any specific study, data, or trial design for manuka honey itself.", "directness": "indirect", "limitations": "The abstract does not describe the studies behind the manuka honey product claim, and the review's main focus is silk fibroin scaffolds, not manuka honey; population is diabetic foot ulcers, not anorectal surgery.", "followUp": "", "plainFinding": "Barely mentioned, no real data given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42544260/", "sourceText": "Diabetic foot ulcers (DFUs) represent a growing clinical challenge, driven by an aging global population and the increasing prevalence of diabetes. Affecting millions worldwide, DFUs remain one of the most serious complications of diabetes, frequently progressing to infection, amputation, and elevated mortality. Standard treatments typically include pressure offloading, circulation improvement, infection control, and topical wound care; however, many chronic DFUs fail to respond to these interventions due to persistent inflammation, impaired vascularization, and microbial burden. These challenges have accelerated interest in regenerative medicine approaches, including stem cells, growth factors, and skin substitutes. Among these, skin substitutes have shown particular promise; among Food and Drug Administration-approved options, products such as the collagen-Manuka honey-hydroxyapatite patch from SweetBio (Apis®) have demonstrated improved outcomes in patients with chronic ulcers. Silk fibroin (SF), a natural biopolymer with established clinical use, has emerged as a promising platform for chronic wound management due to its biocompatibility, tunable degradation, and capacity for controlled bio-additive delivery. SF scaffolds can be fabricated through various methods tailored to wound-healing applications: electrospun fibrous mats with high surface-area-to-volume ratio, freeze-dried porous constructs with interconnected architecture, and hydrogels designed for controlled drug delivery. In this review, we critically examine how SF scaffolds enhanced with bio-additives modulate cellular responses, redirect dysregulated healing pathways, accelerate wound closure, and promote tissue regeneration in diabetic wounds. We synthesize recent advances in preclinical and clinical studies, identify key translational barriers, and outline future directions for advancing SF-based dressings toward clinical adoption. Collectively, this review positions bio-enhanced SF scaffolds as next-generation, disease-informed candidates for improving outcomes in chronic DFU care.", "provenance": [ { "field": "population", "quote": "Diabetic foot ulcers (DFUs) represent a growing clinical challenge" }, { "field": "intervention", "quote": "Silk fibroin (SF), a natural biopolymer with established clinical use, has emerged as a promising platform for chronic wound management" }, { "field": "comparator", "quote": "Standard treatments typically include pressure offloading, circulation improvement, infection control, and topical wound care" }, { "field": "primaryOutcome", "quote": "modulate cellular responses, redirect dysregulated healing pathways, accelerate wound closure, and promote tissue regeneration in diabetic wounds" }, { "field": "result", "quote": "products such as the collagen-Manuka honey-hydroxyapatite patch from SweetBio (Apis®) have demonstrated improved outcomes in patients with chronic ulcers" } ] }, { "id": "pmid:42247330", "pmid": "42247330", "doi": "10.12968/jowc.2025.0073", "nctId": null, "pmcid": null, "title": "Impact of advanced wound care methods on obstetric patients: a meta-analysis", "firstAuthor": "Fang", "multipleAuthors": true, "journal": "J Wound Care", "year": 2026, "design": "meta-analysis", "n": 1977, "nField": "reported", "population": "women with surgical wounds from obstetric procedures like C-sections and episiotomies", "intervention": "advanced wound care methods such as bioactive dressings, antimicrobials, and organic gels including honey, aloe vera, and turmeric", "comparator": "standard wound care methods", "primaryOutcome": "wound healing", "result": "pooled risk ratio of 0.97 (95% CI 0.81 to 1.16), no significant difference between groups", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "The studies pooled were highly variable (I2=78%) and mixed many different treatments together, including honey as just one of several options, so it's hard to know what any single treatment like manuka honey does.", "directness": "indirect", "limitations": "Substantial heterogeneity across studies (I2=78%); pooled multiple different AWC interventions together rather than isolating honey specifically; population is obstetric wounds, not anorectal surgery wounds.", "followUp": "", "plainFinding": "No significant difference overall.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42247330/", "sourceText": "OBJECTIVE: Obstetric procedures, including caesarean sections and episiotomies, often result in surgical wounds requiring effective management to prevent complications. Advanced wound care (AWC) methods-such as bioactive dressings, topical antimicrobials and medicated creams-are increasingly used to enhance healing outcomes. This meta-analysis aimed to quantitatively assess the efficacy of AWC interventions compared to standard methods in obstetric patients. METHOD: A comprehensive literature search (2003-2023) identified relevant randomised controlled trials and observational studies. Using the metabin function from the R meta package, data from studies were pooled to assess wound healing efficacy. Heterogeneity and publication bias were also evaluated. RESULTS: A total of 11 studies comprising 1977 patients were analysed. AWC methods, including organic gels (e.g., aloe vera, honey, turmeric), antibiotic dressings, and topical formulations were associated with improved wound healing in several studies. However, the pooled risk ratio was 0.97 with a 95% confidence interval of 0.81 to 1.16, indicating no statistically significant difference between AWC and standard treatments. Substantial heterogeneity was observed across studies (I2=78%; τ2=0.0734; p<0.01), reflecting variability in treatment effects. A random-effects model was employed to account for this variation. Egger's test for publication bias was not significant (p=0.9778), suggesting minimal risk of bias in the included studies. CONCLUSION: While several studies indicated promising outcomes with AWC approaches, the overall pooled estimate did not reach statistical significance. These findings suggest that although AWC methods may offer clinical value, further high-quality, stratified research is needed to confirm their efficacy and clarify patient-specific benefits.", "provenance": [ { "field": "n", "quote": "A total of 11 studies comprising 1977 patients were analysed." }, { "field": "population", "quote": "Obstetric procedures, including caesarean sections and episiotomies, often result in surgical wounds requiring effective management to prevent complications." }, { "field": "intervention", "quote": "Advanced wound care (AWC) methods-such as bioactive dressings, topical antimicrobials and medicated creams-are increasingly used to enhance healing outcomes." }, { "field": "intervention", "quote": "AWC methods, including organic gels (e.g., aloe vera, honey, turmeric), antibiotic dressings, and topical formulations were associated with improved wound healing in several studies." }, { "field": "comparator", "quote": "This meta-analysis aimed to quantitatively assess the efficacy of AWC interventions compared to standard methods in obstetric patients." }, { "field": "primaryOutcome", "quote": "pooled to assess wound healing efficacy" }, { "field": "result", "quote": "the pooled risk ratio was 0.97 with a 95% confidence interval of 0.81 to 1.16, indicating no statistically significant difference between AWC and standard treatments" } ] }, { "id": "pmid:42216526", "pmid": "42216526", "doi": "10.31083/FBL50459", "nctId": null, "pmcid": null, "title": "Fabrication and Characterization of Silk-Fibroin, Polyvinyl Alcohol, and Natural Compounds-Derived Bioscaffold to Accelerate Wound Healing", "firstAuthor": "Sinha", "multipleAuthors": true, "journal": "Front Biosci (Landmark Ed)", "year": 2026, "design": "lab", "n": null, "nField": "not-reported", "population": "human umbilical vein endothelial cells and lab assays (not patients)", "intervention": "a bioscaffold made of silk fibroin, polyvinyl alcohol, manuka honey, fenugreek extract, and ghrelin", "comparator": "no comparator described beyond assay controls", "primaryOutcome": "cell toxicity, migration, proliferation, and antioxidant activity in lab tests", "result": "the scaffold was non-toxic, improved cell migration and proliferation, and showed strong antioxidant activity in lab tests", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a cell and material science lab study, not a test in humans, so it cannot show whether this helps real wounds heal.", "directness": "indirect", "limitations": "lab-only in-vitro testing with no animal or human wound data, and honey is only one of several combined ingredients so its individual effect cannot be separated", "followUp": "", "plainFinding": "Lab material shows wound-healing potential, untested in people.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42216526/", "sourceText": "BACKGROUND: Impaired wound healing represents a significant clinical challenge. Persistent inflammation, excessive reactive oxygen species, and impaired angiogenesis are key mechanisms underlying nonhealing ulcers. We developed a multifunctional bioscaffold incorporating natural bioactive compounds as a mechanistic therapeutic strategy. METHODS: Polyvinyl alcohol and silk fibroin formed the scaffold matrix, blended with Manuka honey, fenugreek seed extract, and Ghrelin for their antioxidant and proangiogenic properties. RESULTS: Scanning electron microscopy revealed defect-free nanofibers with diameters below 200 nm. Fourier-transform infrared analysis confirmed successful incorporation of the bioactive components, indicating effective interactions within the polyvinyl alcohol (PVA)-silk fibroin (SF) matrix. Thermal analysis demonstrated improved thermal stability upon addition of the bioactive agents. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay confirmed the absence of toxicity. Scratch assays confirmed enhanced migration of human umbilical vein endothelial cells, supporting the scaffold's angiogenic potential. Additionally, the scaffold exhibited superior antioxidant activity and significantly improved cell proliferation. CONCLUSIONS: These findings demonstrate that the developed bioscaffold integrates antioxidant and proangiogenic properties, making it a promising candidate for various biomedical applications, particularly in wound dressings, drug delivery, tissue engineering, and biosensing.", "provenance": [ { "field": "population", "quote": "Scratch assays confirmed enhanced migration of human umbilical vein endothelial cells" }, { "field": "intervention", "quote": "Polyvinyl alcohol and silk fibroin formed the scaffold matrix, blended with Manuka honey, fenugreek seed extract, and Ghrelin for their antioxidant and proangiogenic properties." }, { "field": "primaryOutcome", "quote": "The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay confirmed the absence of toxicity. Scratch assays confirmed enhanced migration of human umbilical vein endothelial cells, supporting the scaffold's angiogenic potential." }, { "field": "result", "quote": "Additionally, the scaffold exhibited superior antioxidant activity and significantly improved cell proliferation." }, { "field": "comparator", "quote": "BACKGROUND: Impaired wound healing represents a significant clinical challenge." } ] }, { "id": "pmid:42117760", "pmid": "42117760", "doi": "10.1111/iwj.70939", "nctId": null, "pmcid": "PMC13163150", "title": "Clinical and Postoperative Applications of Manuka Honey in Wound Healing: An Evidence-Based Review", "firstAuthor": "Alhabsi", "multipleAuthors": true, "journal": "Int Wound J", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "patients with chronic or postoperative surgical wounds", "intervention": "Manuka honey applied to wounds", "comparator": "not clearly specified across included studies", "primaryOutcome": "wound healing, infection control and bacterial load", "result": "reduced bacterial load, faster healing and improved comfort reported across clinical studies", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a narrative review of mixed study types without statistical pooling, and it admits that robust high-quality surgical trials are still needed.", "directness": "indirect", "limitations": "the abstract itself calls for standardised protocols and robust, high-quality surgical trials, indicating the current evidence base is not strong or consistent", "followUp": "", "plainFinding": "May help wounds heal faster", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42117760/", "sourceText": "Chronic and postoperative wounds remain challenging to manage, with high risks of infection, delayed healing and increased costs. Manuka honey offers antibacterial, anti-inflammatory, antioxidant and tissue-regenerative properties through methylglyoxal, phenolic compounds, high sugar content and low pH. The main objective is to review the mechanisms, clinical outcomes and applications of Manuka honey in wound care. A narrative review of PubMed, Scopus and Google Scholar identified studies on surgical site management, graft or flap bed preparation, chronic wounds and novel delivery systems, prioritising randomised controlled trials and high-quality observational data. Results have shown that Manuka honey demonstrates broad-spectrum antimicrobial and antibiofilm effects, supports non-traumatic debridement and modulates inflammation to promote granulation and re-epithelialisation. Clinical studies show reduced bacterial load, faster healing and improved comfort in surgical and chronic wounds. Operative uses include pre-grafting bed conditioning, adjunctive treatment for infected wounds and integration with negative pressure wound therapy. Emerging delivery approaches, such as bioengineered honey-collagen dressings and nanofibrous scaffolds, show promise for enhancing postoperative outcomes. To conclude, Manuka honey is a versatile and promising adjunct in modern wound care management. Standardised application protocols and robust, high-quality surgical trials are urgently needed to confirm its effective role in perioperative clinical practice.", "provenance": [ { "field": "population", "quote": "Chronic and postoperative wounds remain challenging to manage" }, { "field": "intervention", "quote": "Manuka honey offers antibacterial, anti-inflammatory, antioxidant and tissue-regenerative properties" }, { "field": "comparator", "quote": "A narrative review of PubMed, Scopus and Google Scholar identified studies on surgical site management, graft or flap bed preparation, chronic wounds and novel delivery systems" }, { "field": "primaryOutcome", "quote": "Clinical studies show reduced bacterial load, faster healing and improved comfort in surgical and chronic wounds." }, { "field": "result", "quote": "Clinical studies show reduced bacterial load, faster healing and improved comfort in surgical and chronic wounds." }, { "field": "design", "quote": "A narrative review of PubMed, Scopus and Google Scholar identified studies" }, { "field": "limitations", "quote": "Standardised application protocols and robust, high-quality surgical trials are urgently needed to confirm its effective role in perioperative clinical practice." } ] }, { "id": "pmid:42087593", "pmid": "42087593", "doi": "10.17219/acem/213515", "nctId": null, "pmcid": null, "title": "Honey-based dressing vs gelatin sponge for palatal wound healing after free gingival graft harvest: A randomized clinical trial", "firstAuthor": "Molga-Chlipała", "multipleAuthors": true, "journal": "Adv Clin Exp Med", "year": 2026, "design": "rct", "n": 21, "nField": "reported", "population": "patients with gum recession needing palate graft surgery for dental treatment", "intervention": "Manuka honey-coated dressing on the palate wound", "comparator": "gelatin sponge dressing on the palate wound", "primaryOutcome": "pain, discomfort, burning sensation, diet changes, and wound healing after surgery", "result": "no significant difference between honey and gelatin sponge dressings in pain, discomfort, or healing at 14 days", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "very small study with only 21 patients comparing two dressings, not honey versus no treatment, on a different kind of wound than anorectal surgery", "directness": "indirect", "limitations": "small sample size of 21 patients; split-mouth design in dental surgery, not anorectal surgery; no untreated comparison group", "followUp": "14 days", "plainFinding": "Comparable healing to gelatin sponge.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42087593/", "sourceText": "BACKGROUND: Subepithelial connective tissue graft (SCTG) is commonly used in dental procedures and is associated with postoperative discomfort at the palatal donor site. The question is whether the use of a honey-based dressing may improve patients' postoperative experience and promote wound healing. OBJECTIVES: The aim of this study was to compare the effects of a non-adherent viscose net dressing coated with 99% Manuka honey and 1% Manuka oil (Actilite; Advancis Medical, Kirkby-in-Ashfield, UK) and an absorbable hemostatic porcine gelatin sponge (Aegis Lifesciences, Sanand, India) on the healing of the palatal donor site and patient morbidity after free gingival graft (FGG) preparation. MATERIAL AND METHODS: A total of 21 patients (16 females and 5 males) with multiple gingival recessions (GR) were treated using the modified coronally advanced tunnel technique (MCAT) and subepithelial connective tissue graft (SCTG) following FGG de-epithelialization. Two grafts were harvested from both sides of the palate in each patient. Using a split-mouth design, donor sites were randomly assigned to the test group (honey dressing) or the control group (gelatin sponge). The palatal donor sites were evaluated at 1, 2, 4, 7, and 14 days postoperatively for pain, patient discomfort, changes in dietary habits, and burning sensation. Wound healing and delayed bleeding were assessed 2 weeks after surgery. RESULTS: In both the honey group and the gelatin sponge group, no significant differences were observed in postoperative pain, patient discomfort, burning sensation, or changes in dietary habits at 14 days postoperatively (p > 0.05). No prolonged bleeding was observed during the 2-week follow-up, and wound healing was assessed as \"very good\" after 14 days. CONCLUSIONS: Both dressing materials can be successfully used at the palatal donor site after periodontal surgery and result in comparable outcomes in wound healing. Honey dressing may be considered an alternative to traditional dressing methods.", "provenance": [ { "field": "n", "quote": "A total of 21 patients (16 females and 5 males) with multiple gingival recessions (GR) were treated" }, { "field": "population", "quote": "A total of 21 patients (16 females and 5 males) with multiple gingival recessions (GR) were treated" }, { "field": "intervention", "quote": "a non-adherent viscose net dressing coated with 99% Manuka honey and 1% Manuka oil (Actilite; Advancis Medical, Kirkby-in-Ashfield, UK)" }, { "field": "comparator", "quote": "an absorbable hemostatic porcine gelatin sponge (Aegis Lifesciences, Sanand, India)" }, { "field": "primaryOutcome", "quote": "The palatal donor sites were evaluated at 1, 2, 4, 7, and 14 days postoperatively for pain, patient discomfort, changes in dietary habits, and burning sensation." }, { "field": "result", "quote": "no significant differences were observed in postoperative pain, patient discomfort, burning sensation, or changes in dietary habits at 14 days postoperatively (p > 0.05)" } ] }, { "id": "pmid:42084260", "pmid": "42084260", "doi": "10.1097/SCS.0000000000012854", "nctId": null, "pmcid": null, "title": "Manuka Honey in Craniofacial Wound Management: A Narrative Review", "firstAuthor": "Kang", "multipleAuthors": false, "journal": "J Craniofac Surg", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with craniofacial wounds (scalp, head and neck, facial surgical wounds)", "intervention": "Manuka honey applied to wounds", "comparator": "", "primaryOutcome": "evidence supporting wound healing use of Manuka honey", "result": "most evidence came from case reports and small series, with only one randomized controlled trial in head and neck wounds", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a narrative review built mostly from case reports and small series rather than controlled trials, so it can't reliably show whether honey works.", "directness": "indirect", "limitations": "abstract states most available evidence remains at the level of case reports and small series, with only one randomized controlled trial conducted specifically in head and neck wounds", "followUp": "", "plainFinding": "Mostly weak, supportive evidence only.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42084260/", "sourceText": "BACKGROUND: Craniofacial wounds present unique management challenges owing to the aesthetic significance of the facial region, proximity to vital structures, risk of contamination from oral flora, and the frequent presence of exposed bone or hardware. Manuka honey, derived from the Leptospermum scoparium plant, possesses well-documented antimicrobial, anti-inflammatory, and wound healing properties attributable primarily to its methylglyoxal content, osmotic activity, and low pH. However, no review has specifically addressed its application in the craniofacial context. METHODS: A narrative review was conducted using PubMed, Scopus, and Web of Science databases. Search terms combined honey-related keywords with craniofacial and head-and-neck terminology. Clinical studies, case reports, randomized controlled trials, and relevant general wound care reviews were included. The Scale for the Assessment of Narrative Review Articles (SANRA) was used as a quality framework. RESULTS: Evidence supporting the use of Manuka honey in the craniofacial region was identified across several wound categories, including scalp defects with exposed calvarium, head and neck oncologic reconstruction wounds, oral and maxillofacial infections, partial flap necrosis, facial surgical wounds, and burns. In vitro data also suggest selective cytotoxicity against tumor cells, raising the possibility of a dual wound healing and antitumor role in postoncologic surgical wounds. Most available evidence remains at the level of case reports and small series, with only one randomized controlled trial conducted specifically in head and neck wounds. CONCLUSIONS: Manuka honey represents a safe, cost-effective, and promising adjunctive wound care modality for the craniofacial surgeon. Registered medical-grade products are ideal where available, but UMF-certified commercial Manuka honey with verified antimicrobial ratings offers a scientifically rational alternative in regions where medical-grade products are not accessible. Prospective studies evaluating Manuka honey in specific craniofacial wound types are warranted.", "provenance": [ { "field": "population", "quote": "Craniofacial wounds present unique management challenges owing to the aesthetic significance of the facial region" }, { "field": "intervention", "quote": "Manuka honey, derived from the Leptospermum scoparium plant, possesses well-documented antimicrobial, anti-inflammatory, and wound healing properties" }, { "field": "primaryOutcome", "quote": "Evidence supporting the use of Manuka honey in the craniofacial region was identified across several wound categories, including scalp defects with exposed calvarium, head and neck oncologic reconstruction wounds, oral and maxillofacial infections, partial flap necrosis, facial surgical wounds, and burns." }, { "field": "result", "quote": "Most available evidence remains at the level of case reports and small series, with only one randomized controlled trial conducted specifically in head and neck wounds." } ] }, { "id": "pmid:42068250", "pmid": "42068250", "doi": "10.12968/jowc.2023.0159", "nctId": null, "pmcid": null, "title": "Effectiveness of Biodress versus both honey and povidone-iodine ointment in acute wound healing in Enugu State, Nigeria: a randomised controlled trial", "firstAuthor": "Anetekhai", "multipleAuthors": true, "journal": "J Wound Care", "year": 2026, "design": "rct", "n": 42, "nField": "reported", "population": "adults with acute wounds treated at two hospitals in southeast Nigeria", "intervention": "honey dressing", "comparator": "petroleum-based Biodress dressing and povidone-iodine ointment", "primaryOutcome": "wound closure", "result": "no significant difference between honey, Biodress and povidone-iodine on wound closure overall, but Biodress showed an advantage over honey specifically for burns", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Very small single-blinded trial (42 patients) comparing honey of unspecified type to other dressings, not manuka honey specifically.", "directness": "indirect", "limitations": "Small sample size, honey type not specified as manuka, population is general acute wounds (including burns) rather than anorectal surgery patients.", "followUp": "", "plainFinding": "No overall difference; worse than Biodress for burns.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42068250/", "sourceText": "OBJECTIVE: To determine the effectiveness of Biodress (a petroleum-based hydrogen-calcium salt of oxidised cellulose dressing made of organic materials; Bottu, Morocco) against both honey and povidone-iodine ointment on wound closure, the incidence of wound complications, the cost of wound care, ease of use, and the outcome of acute wounds. METHOD: A single-blinded randomised controlled trial (RCT) was performed among patients with acute wounds selected from two hospitals in southeast Nigeria. Participants were randomised with computer-generated numbers into one of three equally-sized groups: the petroleum-based dressing used as the intervention, and either honey or povidone-iodine which were used as two independent control groups. RESULTS: A total of 42 patients were included in this RCT, median age 32.5 years, with 22 male and 20 female patients. No significant difference was observed in the effectiveness of the petroleum-based dressing over honey or povidone-iodine ointment on wound closure (p=0.288). However, considering injury type, Biodress showed some advantage over honey in burns injuries (p=0.017). None of the participants in the intervention group had wound infection at any of the follow-up visits. No significant difference was noted in the cost of dressing materials (dressing packs and cleansing solutions) (p=0.717), or in the cost of dressing agents (Biodress/honey/ povidone-iodine) (p=0.222). Similarly, there was no significant difference in the ease of use of the different materials. The petroleum-based dressing, however, was significantly less painful than the other dressing agents and required significantly fewer dressing materials per episode compared to the other dressings (p=0.001). CONCLUSION: In this RCT, Biodress demonstrated its potential as a promising dressing agent for acute wounds, particularly burns injuries; however, further studies will help to substantiate or disprove this finding.", "provenance": [ { "field": "n", "quote": "A total of 42 patients were included in this RCT" }, { "field": "population", "quote": "A single-blinded randomised controlled trial (RCT) was performed among patients with acute wounds selected from two hospitals in southeast Nigeria." }, { "field": "intervention", "quote": "honey or povidone-iodine which were used as two independent control groups" }, { "field": "comparator", "quote": "the petroleum-based dressing used as the intervention" }, { "field": "primaryOutcome", "quote": "No significant difference was observed in the effectiveness of the petroleum-based dressing over honey or povidone-iodine ointment on wound closure" }, { "field": "result", "quote": "No significant difference was observed in the effectiveness of the petroleum-based dressing over honey or povidone-iodine ointment on wound closure (p=0.288). However, considering injury type, Biodress showed some advantage over honey in burns injuries (p=0.017)." } ] }, { "id": "pmid:41982668", "pmid": "41982668", "doi": "10.3389/fphar.2026.1790277", "nctId": null, "pmcid": "PMC13071066", "title": "Manuka honey as a natural remedy for diabetic foot ulcers: efficacy compared with silver-based dressing", "firstAuthor": "Rojczyk", "multipleAuthors": true, "journal": "Front Pharmacol", "year": 2026, "design": "rct", "n": 60, "nField": "reported", "population": "patients with diabetic foot ulcers", "intervention": "medical-grade Manuka honey dressing", "comparator": "silver-containing calcium alginate dressing", "primaryOutcome": "wound healing progress measured by RESVECH 2.0 score after 4 weeks", "result": "Manuka honey group showed significantly greater wound improvement than silver dressing group, with total score reduced by 41.3% vs 2.0%", "resultDirection": "benefit", "quality": "low", "qualityWhy": "small randomized trial of only 60 patients with a short 4-week follow-up limits confidence in the findings.", "directness": "indirect", "limitations": "Small sample size and short follow-up period of only 4 weeks; studies diabetic foot ulcers, not anorectal surgical wounds.", "followUp": "4 weeks", "plainFinding": "Better healing than silver dressings", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41982668/", "sourceText": "INTRODUCTION: Diabetic foot ulcers (DFUs) present significant challenges in clinical management. Numerous studies have confirmed the effectiveness of honey in promoting the healing of cutaneous ulcers of various etiologies, including DFUs. The aim of the study is to compare the effectiveness of DFUs treatment with Manuka honey with the use of a classic silver-based dressing. METHODS: A randomized controlled trial was conducted involving two groups of patients (a total of 60 individuals) with DFUs. Patients were randomly assigned to two groups: the experimental group received treatment with medical-grade Manuka honey, whereas the control group was treated with a silver-containing calcium alginate dressing. The investigated Manuka honey product was reported with full device identifiers to ensure clinical-grade product traceability. RESVECH 2.0 Scoring Table was used twice (just before procedure and after 4 weeks) to assess treatment effectiveness. It is a validated multidimensional scale designed to assess and monitor the progression of chronic wound healing across key clinical parameters. RESULTS: With the exception of Depth/Tissues Involved, all evaluated parameters of RESVECH 2.0 Scoring Table demonstrated a significantly greater improvement in the experimental group compared with the control group (p < 0.001). Total score was reduced by 41.3% in the experimental group vs. 2.0% in the control group. Statistically significant, mostly positive correlations were found between wounding time and RESVECH 2.0 scores before and after 4 weeks of therapy, as well as between wounding time and the magnitude of treatment effect. DISCUSSION: Manuka honey demonstrated greater efficacy than silver-based dressings in promoting the healing of diabetic foot ulcers, supporting its use as an effective alternative in clinical practice.", "provenance": [ { "field": "population", "quote": "two groups of patients (a total of 60 individuals) with DFUs" }, { "field": "intervention", "quote": "the experimental group received treatment with medical-grade Manuka honey" }, { "field": "comparator", "quote": "the control group was treated with a silver-containing calcium alginate dressing" }, { "field": "primaryOutcome", "quote": "RESVECH 2.0 Scoring Table was used twice (just before procedure and after 4 weeks) to assess treatment effectiveness" }, { "field": "result", "quote": "Total score was reduced by 41.3% in the experimental group vs. 2.0% in the control group" }, { "field": "n", "quote": "a total of 60 individuals" } ] }, { "id": "pmid:41956357", "pmid": "41956357", "doi": "10.1016/j.ijpharm.2026.126856", "nctId": null, "pmcid": null, "title": "Gellan gum/honey-based gels and hydrogels for cutaneous wound management", "firstAuthor": "Costa", "multipleAuthors": true, "journal": "Int J Pharm", "year": 2026, "design": "lab", "n": null, "nField": "not-reported", "population": "Laboratory study developing wound-care gels, not tested in patients", "intervention": "Gellan gum combined with multiflora honey formed into gels and hydrogels", "comparator": "Different gel/hydrogel formulations with varying honey and gellan gum concentrations compared to each other", "primaryOutcome": "Physical properties, antimicrobial activity, and effects on cell growth/migration in lab tests", "result": "Honey-gellan gum gels showed good wound debridement and sustained release properties; cells initially slowed but then recovered proliferation and migration", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is early-stage laboratory and cell-culture work, not a study in real wounds or patients, so it cannot show whether the honey gel actually helps people heal.", "directness": "indirect", "limitations": "No human or animal wound testing; honey used was multiflora (not manuka); results based only on lab material testing and cell culture.", "followUp": "", "plainFinding": "Promising lab results, not tested in people.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41956357/", "sourceText": "Wound healing is complex and still requires targeted therapies and advanced dressings despite current advances. Honey (HNY) is a multifunctional bioactive agent with demonstrated benefits across various phases of healing. Here, we present a wound stage-specific formulation strategy that combines a previously uncharacterized multiflora HNY from Monte Novo (Portalegre, Portugal) with gellan gum (GG) to develop gels for osmolarity-driven debridement and hydrogels for sustained release of bioactive components post-debridement, thereby enhancing therapeutic outcomes. The amount of sugars and phenolic compounds in the HNY were consistent with its hyperosmotic nature and anti-oxidant and anti-microbial activity. Gels were prepared using 0.1 and 0.2% GG with 50-90% HNY to reduce HNY's inherent flowability and enhance retention at the wound site, while maintaining extrudability. Hydrogels were formulated with higher GG (0.75 and 1.25%) to form mechanically stable crosslinked networks, and lower HNY (10-40%) to reduce osmolarity while preserving bioactivity. All gel formulations were extrudable and demonstrated effective water absorption. Those with higher GG and lower HNY exhibited increased viscosity, required greater force to flow, and displayed solid-like behavior, favoring wound retention. The 80% HNY-0.2% GG formulation balanced viscosity and osmotic strength, as confirmed by cytotoxicity results, while preserving anti-microbial activity indicating suitability for wound debridement. Hydrogels showed increased stiffness with higher GG and HNY while maintaining HNY's bioactive constituents. The 30% HNY-1.25% GG formulation demonstrated superior stability and sustained release of HNY components, including phenolic compounds at levels supporting anti-inflammatory and healing effects. Although initial HNY hydrogel exposure reduced cell metabolic activity, cells recovered over time, maintaining proliferation and migratory function. Collectively, these findings highlight the potential of GG/HNY gel/hydrogel formulations to support wound management across different healing stages, offering effective debridement through osmotic action and prolonged therapeutic support via controlled bioactive components release.", "provenance": [ { "field": "population", "quote": "Wound healing is complex and still requires targeted therapies and advanced dressings despite current advances." }, { "field": "intervention", "quote": "combines a previously uncharacterized multiflora HNY from Monte Novo (Portalegre, Portugal) with gellan gum (GG) to develop gels for osmolarity-driven debridement and hydrogels for sustained release of bioactive components post-debridement" }, { "field": "comparator", "quote": "Gels were prepared using 0.1 and 0.2% GG with 50-90% HNY" }, { "field": "primaryOutcome", "quote": "All gel formulations were extrudable and demonstrated effective water absorption." }, { "field": "result", "quote": "Although initial HNY hydrogel exposure reduced cell metabolic activity, cells recovered over time, maintaining proliferation and migratory function." } ] }, { "id": "pmid:41928876", "pmid": "41928876", "doi": "10.3389/fendo.2026.1759703", "nctId": null, "pmcid": "PMC13038560", "title": "Honey dressing for diabetic foot ulcers: a systematic review and meta-analysis of randomized controlled trials", "firstAuthor": "Yao", "multipleAuthors": true, "journal": "Front Endocrinol (Lausanne)", "year": 2026, "design": "meta-analysis", "n": 1423, "nField": "reported", "population": "people with diabetic foot ulcers", "intervention": "honey dressing", "comparator": "conventional wound dressings", "primaryOutcome": "complete wound healing rate and time to complete healing", "result": "honey dressing improved complete healing rate and reduced healing time compared to conventional dressings", "resultDirection": "benefit", "quality": "low", "qualityWhy": "the review itself graded the evidence as low to moderate quality using GRADE", "directness": "indirect", "limitations": "evidence quality graded low for time to healing and moderate for healing rate; not manuka honey specifically and not anorectal surgery wounds", "followUp": "4 to 24 weeks", "plainFinding": "Faster, more complete healing of foot ulcers", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41928876/", "sourceText": "BACKGROUND: To systematically evaluate the efficacy and safety of honey dressing compared to conventional dressings in the treatment of DFUs. METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines. PubMed, BIOSIS, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar internet were searched from inception to Jan 31, 2026 for RCTs comparing honey dressing with conventional dressings in DFU patients. Primary outcomes were complete wound healing rate and time to complete healing. Risk of bias was assessed using the Cochrane RoB 2.0 tool. The quality of evidence was graded through the Grading of Recommendations Assessment Development and Evaluations (GRADE) approach. RESULTS: Sixteen RCTs involving 1423 participants were included. The sample sizes ranged from 23 to 348 participants. The follow-up duration varied from 4 to 24 weeks. Meta-analysis showed that honey dressing significantly improved the complete healing rate (OR 2.28, 95% CI 1.76 to 2.95) and reduced the time to complete healing (MD -4.38, 95% CI -8.06 to -0.71) compared to controls. According to the GRADE system, the overall quality of evidence for the outcomes of time to healing was rated as 'Low', and the quality of evidence for the outcomes of healing rate was rated as 'moderate'. CONCLUSION: Honey dressing is a safe and more effective intervention for DFUs than conventional dressings, associated with significantly improved healing rates and faster healing time. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251244450, identifier CRD420251244450.", "provenance": [ { "field": "n", "quote": "Sixteen RCTs involving 1423 participants were included" }, { "field": "population", "quote": "honey dressing with conventional dressings in DFU patients" }, { "field": "intervention", "quote": "honey dressing" }, { "field": "comparator", "quote": "conventional dressings" }, { "field": "primaryOutcome", "quote": "Primary outcomes were complete wound healing rate and time to complete healing" }, { "field": "result", "quote": "honey dressing significantly improved the complete healing rate (OR 2.28, 95% CI 1.76 to 2.95) and reduced the time to complete healing (MD -4.38, 95% CI -8.06 to -0.71) compared to controls" }, { "field": "followUp", "quote": "The follow-up duration varied from 4 to 24 weeks" } ] }, { "id": "pmid:41841442", "pmid": "41841442", "doi": "10.1080/00016489.2026.2640609", "nctId": null, "pmcid": null, "title": "Topical honey as adjunctive therapy to standard dressing in deep neck abscess: a single-blind randomized controlled trial", "firstAuthor": "Wulandari", "multipleAuthors": true, "journal": "Acta Otolaryngol", "year": 2026, "design": "rct", "n": null, "nField": "not-reported", "population": "patients with deep neck abscess", "intervention": "standard wound dressing plus honey", "comparator": "standard wound dressing alone", "primaryOutcome": "wound size, inflammation markers, pain, and healing-related measures", "result": "comparable clinical outcomes to standard dressings, with greater reductions in inflammatory markers and increased VEGF expression", "resultDirection": "mixed", "quality": "low", "qualityWhy": "The abstract does not report the number of patients, and the trial was only single-blind with outcomes based partly on biomarkers rather than confirmed clinical healing differences.", "directness": "indirect", "limitations": "Abstract does not specify participant numbers, honey type (not stated as manuka), or blinding beyond single-blind design; population is deep neck abscess, not anorectal surgery wounds.", "followUp": "", "plainFinding": "Similar healing, better inflammation markers.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41841442/", "sourceText": "BACKGROUND: Deep neck abscess (DNA) is a otorhinolaryngological condition associated with morbidity, mortality, high treatment costs, and long-term wound care. Optimizing wound management is essential to improve outcomes and reduce healthcare burden. Honey is expected to be an effective treatment modality and may serve as an effective adjunctive therapy. OBJECTIVE: To compare the effectiveness of standard wound dressing combined with honey versus standard dressing in patients with DNA, based on wound size, Bates-Jensen Wound Assessment Tool (BWATs) scores, Visual Analog Scale (VAS), white blood cell (WBC) count, bacterial colony growth, and expression of interleukin-1 (IL-1), tumor necrosis factor-α (TNF-α), and vascular endothelial growth factor (VEGF). METHODS: A single-blind randomized controlled trial was conducted at Dr. Sardjito General Hospital between May 2024 and June 2025. Participants received either standard dressing or standard dressing supplemented with honey. Outcomes were analyzed using appropriate parametric and nonparametric statistical methods. RESULTS: Honey supplementation showed comparable clinical outcomes to standard dressings, demonstrated greater reductions in inflammatory markers (IL-1, TNF-α) and increased VEGF expression. CONCLUSION: Honey as an adjunct to standard dressing may serve as an effective adjunct DNA wound healing by enhancing anti-inflammatory and proliferative responses.", "provenance": [ { "field": "population", "quote": "patients with DNA" }, { "field": "intervention", "quote": "standard dressing supplemented with honey" }, { "field": "comparator", "quote": "standard dressing" }, { "field": "primaryOutcome", "quote": "wound size, Bates-Jensen Wound Assessment Tool (BWATs) scores, Visual Analog Scale (VAS), white blood cell (WBC) count, bacterial colony growth, and expression of interleukin-1 (IL-1), tumor necrosis factor-α (TNF-α), and vascular endothelial growth factor (VEGF)" }, { "field": "result", "quote": "Honey supplementation showed comparable clinical outcomes to standard dressings, demonstrated greater reductions in inflammatory markers (IL-1, TNF-α) and increased VEGF expression." }, { "field": "design", "quote": "A single-blind randomized controlled trial was conducted" } ] }, { "id": "pmid:41816212", "pmid": "41816212", "doi": "10.3389/fendo.2026.1780580", "nctId": null, "pmcid": "PMC12971454", "title": "The efficacy of three antimicrobial dressings in the management of diabetic foot ulcers: a systematic review and network meta-analysis", "firstAuthor": "He", "multipleAuthors": true, "journal": "Front Endocrinol (Lausanne)", "year": 2026, "design": "meta-analysis", "n": 1292, "nField": "reported", "population": "People with diabetic foot ulcers", "intervention": "Honey dressings, silver dressings, or antibiotic-impregnated bone cement for foot ulcers", "comparator": "Standard wound care", "primaryOutcome": "Wound healing rate and healing time", "result": "The abstract reports that antibiotic bone cement and silver dressings healed wounds faster and better than standard care, but it does not give specific comparative results for honey dressings.", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "It pools 15 randomized trials with over a thousand patients, but does not separately report how honey dressings performed and relies on indirect network comparisons.", "directness": "indirect", "limitations": "The abstract does not report individual trial quality, does not give specific results for honey dressings versus other treatments, and studies diabetic foot ulcers rather than anorectal surgical wounds.", "followUp": "", "plainFinding": "Honey results not specifically reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41816212/", "sourceText": "BACKGROUND: Antimicrobial dressings have been used to treat diabetic foot ulcers (DFU). However, no direct or indirect comparison among silver dressings, honey dressings or antibiotic-impregnated bone cement (ABC) for DFU has been performed to date. OBJECTIVE: To systematically evaluate the efficacy of the three antimicrobial dressings in the management of DFU. METHODS: A comprehensive search of PubMed, Embase, The Cochrane Library, and Web of Science was conducted to identify randomized controlled trials (RCTs) comparing silver dressings, honey dressings, and ABC in the treatment of DFU, from database inception to November 2025. Two investigators in-dependently performed study selection, data extraction, and assessment of risk of bias. Data analyses were conducted using Stata 18.0. RESULTS: A total of 15 RCTs encompassing 1,292 patients were included. The network meta-analysis revealed that ABC demonstrated superiority over standard care in both healing rate and healing time (OR = 4.06, 95% CI [1.48, 11.1], P < 0.05; SMD = -2.25, 95% CI [-4.11, -0.40], P < 0.05). Silver dressings also outperformed standard care in terms of healing rate and wound area reduction (OR = 2.31, 95% CI [1.14, 4.69], P < 0.05; SMD = 1.43, 95% CI [0.39, 2.47], P < 0.05). Based on the surface under the cumulative ranking curve, ABC and silver dressings ranked as the most favorable therapeutic options. CONCLUSIONS: According to the network meta-analysis and SUCRA ranking results, an-tibiotic bone cement and silver dressings appear to be the most advantageous strategies for DFU management. Future studies should include direct comparisons among various antimicrobial dressings and incorporate cost-effectiveness analyses to guide optimal clinical decision-making. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024578370, identifier CRD42024578370.", "provenance": [ { "field": "population", "quote": "A total of 15 RCTs encompassing 1,292 patients were included." }, { "field": "intervention", "quote": "comparing silver dressings, honey dressings, and ABC in the treatment of DFU" }, { "field": "comparator", "quote": "ABC demonstrated superiority over standard care in both healing rate and healing time" }, { "field": "primaryOutcome", "quote": "healing rate and healing time" }, { "field": "result", "quote": "ABC demonstrated superiority over standard care in both healing rate and healing time (OR = 4.06, 95% CI [1.48, 11.1], P < 0.05; SMD = -2.25, 95% CI [-4.11, -0.40], P < 0.05). Silver dressings also outperformed standard care in terms of healing rate and wound area reduction (OR = 2.31, 95% CI [1.14, 4.69], P < 0.05; SMD = 1.43, 95% CI [0.39, 2.47], P < 0.05)." }, { "field": "n", "quote": "A total of 15 RCTs encompassing 1,292 patients were included." } ] }, { "id": "pmid:41474823", "pmid": "41474823", "doi": "10.1371/journal.pntd.0013454", "nctId": null, "pmcid": "PMC12774343", "title": "A randomised controlled trial of raw honey for the healing of ulcers in leprosy in Nigeria", "firstAuthor": "Tsaku", "multipleAuthors": true, "journal": "PLoS Negl Trop Dis", "year": 2025, "design": "rct", "n": 130, "nField": "reported", "population": "people with leprosy-related foot ulcers in Nigeria", "intervention": "raw honey wound dressings", "comparator": "standard saline dressings", "primaryOutcome": "complete ulcer healing by 84 days and rate of healing", "result": "no significant difference in healing between honey and saline, though honey showed a non-significant trend toward faster healing", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "it was a randomised trial but was single-blinded, modest in size, and found no statistically significant benefit.", "directness": "indirect", "limitations": "single-blinded design, non-significant trend only, leprosy ulcers not anorectal surgical wounds", "followUp": "6 months", "plainFinding": "No significant benefit over saline.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41474823/", "sourceText": "INTRODUCTION: Chronic neuropathic ulcers remain a debilitating complication of leprosy, with limited evidence for effective treatments. Honey has been recommended to promote wound healing in other chronic ulcers. However, its efficacy in ulcer healing has not been rigorously evaluated. METHODS: This dual-centre, prospective, single-blinded, randomised controlled trial compared raw honey dressings (n = 65) versus standard saline dressings (n = 65) for leprosy-associated foot ulcers in Nigeria. Participants with ulcers (2-20 cm2, ≥ 6 weeks duration) were randomised 1:1, stratified by ulcer size. Primary outcomes were complete healing by 84 days and healing rate, assessed through blinded digital planimetry. Secondary outcomes included ulcer recurrence and/or new ulcer development at 6 months. A total of 130 participants were randomised in the study. RESULTS: Complete healing occurred in 29.2% of honey-treated ulcers versus 24.6% with saline (adjusted HR 1.26, 95% CI 0.64-2.47). At 6 months, recurrence rates were similar (honey 13.5% vs saline 10.2%). The honey group showed a non-significant trend toward faster healing (p = 0.076). No treatment-related adverse events occurred. CONCLUSION: While honey dressings showed a modest advantage in healing rate, the difference was not statistically significant. The results suggest honey may be a safe, culturally acceptable option in resource-limited settings. This study provides high-quality data for inclusion in future systematic reviews. TRIAL REGISTRATION: ISRCTN10093277. Registered on 22 December 2021.", "provenance": [ { "field": "n", "quote": "A total of 130 participants were randomised in the study." }, { "field": "population", "quote": "leprosy-associated foot ulcers in Nigeria" }, { "field": "intervention", "quote": "raw honey dressings (n = 65)" }, { "field": "comparator", "quote": "standard saline dressings (n = 65)" }, { "field": "primaryOutcome", "quote": "Primary outcomes were complete healing by 84 days and healing rate, assessed through blinded digital planimetry." }, { "field": "result", "quote": "Complete healing occurred in 29.2% of honey-treated ulcers versus 24.6% with saline (adjusted HR 1.26, 95% CI 0.64-2.47)." }, { "field": "result", "quote": "The honey group showed a non-significant trend toward faster healing (p = 0.076)." } ] }, { "id": "pmid:40958987", "pmid": "40958987", "doi": "10.14740/jocmr6312", "nctId": null, "pmcid": "PMC12434934", "title": "The Elimination Effect of Medical-Grade Honey on Pseudomonas aeruginosa Biofilms: A Systematic Review and Meta-Analysis", "firstAuthor": "Hariyudo", "multipleAuthors": true, "journal": "J Clin Med Res", "year": 2025, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "Pseudomonas aeruginosa biofilms grown in lab experiments (in vitro), not patients", "intervention": "medical-grade honey (including Manuka and Surgihoney) applied to bacterial biofilms", "comparator": "untreated biofilm controls, sugar solutions, and methylglyoxal alone", "primaryOutcome": "reduction and disruption of bacterial biofilm formation", "result": "medical-grade honey significantly reduced biofilm formation and disrupted established biofilms compared to controls", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a meta-analysis of only in vitro lab experiments on bacteria, not on real wounds or patients, so it cannot show whether honey helps people heal.", "directness": "indirect", "limitations": "Only in vitro studies included; sterility control comparisons showed high variability; based on six studies with subgroup heterogeneity.", "followUp": "", "plainFinding": "Honey kills bacterial biofilms in lab dishes.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40958987/", "sourceText": "BACKGROUND: This systematic review aimed to evaluate the efficacy of medical-grade honey (MGH) in eliminating and inhibiting Pseudomonas aeruginosa (P. aeruginosa) biofilms, which are known for their resistance to conventional antibiotics and significant role in chronic infections. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered in PROSPERO (CRD42024614542), a systematic search was conducted across PubMed, ProQuest, Scopus, and EBSCO using terms related to P. aeruginosa, biofilm, and MGH. Inclusion criteria encompassed in vitro studies assessing MGH's effect on P. aeruginosa biofilms, with reported outcomes including biofilm inhibition and eradication. Data extraction and risk-of-bias assessment were performed independently by two reviewers using the Quality Assessment Tool for In Vitro Studies (QUIN) tool. Publication bias was estimated through forest plot. RESULTS: A total of 1,934 records were identified from four databases. After screening and full-text review, six in vitro studies met the inclusion criteria for qualitative synthesis, and five were eligible for meta-analysis. All studies evaluated the effect of MGH, including Manuka and Surgihoney, on P. aeruginosa biofilms using crystal violet staining and spectrophotometric analysis. Pooled results showed that MGH significantly reduced biofilm formation (standardized mean difference (SMD) = -4.98; 95% confidence interval (CI): -6.72 to -3.25) and effectively disrupted established biofilms (SMD = -4.44; 95% CI: -6.62 to -2.26). Subgroup analysis revealed stronger effects on American Type Culture Collection (ATCC) strains than clinical isolates, with low within-subgroup heterogeneity. MGH also demonstrated significant superiority compared to active biofilm controls, although sterility control comparisons showed high variability. Mechanistic analysis found that Medihoney outperformed sugar solutions and methylglyoxal (MGO) alone, suggesting that its antibiofilm activity results from synergistic bioactive compounds. Overall, these findings support MGH as a potent antibiofilm agent, warranting further research for clinical application against P. aeruginosa biofilm infections. CONCLUSION: MGH exhibits consistent and substantial anti-biofilm activity against P. aeruginosa in vitro, affecting both biofilm formation and established biofilms. These findings support its potential application as a topical therapeutic agent in managing biofilm-related infections, particularly in chronic wounds. Future research should prioritize standardized application protocols and investigate synergistic effects with conventional antimicrobials through clinical trials.", "provenance": [ { "field": "population", "quote": "in vitro studies assessing MGH's effect on P. aeruginosa biofilms" }, { "field": "intervention", "quote": "All studies evaluated the effect of MGH, including Manuka and Surgihoney, on P. aeruginosa biofilms" }, { "field": "comparator", "quote": "MGH also demonstrated significant superiority compared to active biofilm controls" }, { "field": "comparator", "quote": "Medihoney outperformed sugar solutions and methylglyoxal (MGO) alone" }, { "field": "primaryOutcome", "quote": "reported outcomes including biofilm inhibition and eradication" }, { "field": "result", "quote": "Pooled results showed that MGH significantly reduced biofilm formation (standardized mean difference (SMD) = -4.98; 95% confidence interval (CI): -6.72 to -3.25) and effectively disrupted established biofilms (SMD = -4.44; 95% CI: -6.62 to -2.26)." } ] }, { "id": "pmid:40810438", "pmid": "40810438", "doi": "10.2196/75475", "nctId": null, "pmcid": "PMC12395109", "title": "Honey as a Wound Care Modality in Treating Deep Neck Space Abscesses: Protocol for a Randomized Controlled Trial", "firstAuthor": "Wulandari", "multipleAuthors": true, "journal": "JMIR Res Protoc", "year": 2025, "design": "registered-trial-no-results", "n": 36, "nField": "reported", "population": "patients with deep neck space abscesses", "intervention": "honey dressings added to standard wound dressings", "comparator": "standard dressings alone", "primaryOutcome": "wound healing measures including cytokines, growth factors, wound size, and bacterial colonies", "result": "This is a study protocol; no results are reported in this abstract", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is only a trial protocol with no outcome data yet reported.", "directness": "indirect", "limitations": "No results are available; this abstract only describes the planned methods and recruitment status.", "followUp": "", "plainFinding": "No results yet, protocol only.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40810438/", "sourceText": "BACKGROUND: Deep neck abscesses are a disease in the field of otorhinolaryngology-head and neck surgery that causes significant morbidity, death, and expenditures. Treatment length, whether inpatient or outpatient, is also prolonged. Deep neck abscesses are managed with incision and drainage, abscess exploration, systemic broad-spectrum antibiotic treatment, comorbidity control, and postoperative wound care through recovery. Standard dressings for wound treatment have proven time-consuming and expensive. Honey is one type of dressing that has long been used in wound treatment for a number of body areas and disorders. OBJECTIVE: The purpose of this study is to investigate the use of honey as a potential substitute for standard dressings for deep neck abscesses. METHODS: This is a single-blind randomized controlled trial. Randomization will be done through simple random sampling. The population and sample of the study include all patients with deep neck abscesses treated at Dr Sardjito General Hospital, which is equipped with board-certified otorhinolaryngologists. Patients with deep neck abscesses who were given ethical clearance and meet the inclusion criteria were recruited as study participants until the sample size was reached. There are 18 participants in each group. Participants in the intervention group received standard dressings in addition to honey dressings, whereas those in the control group received standard dressings alone. Proinflammatory cytokines and growth factors, wound size, Bates-Jensen Wound Assessment Tools scoring, and quantitative bacterial colony identification will be all evaluated and assessed. The gathered data will be documented and subjected to statistical analysis. RESULTS: This manuscript presents a study protocol for a randomized controlled trial investigating honey as a wound care modality in patients with deep neck space abscesses. Ethical approval and partial funding for the study were obtained in May 2024. Recruitment and data collection commenced in June 2024 and were successfully completed as of June 2025. CONCLUSIONS: We hypothesize that honey may serve as a safe, effective, and affordable alternative wound dressing for the management of deep neck abscesses, with potential benefits in both clinical and health care system outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT06562257; https://clinicaltrials.gov/study/NCT06562257. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/75475.", "provenance": [ { "field": "n", "quote": "There are 18 participants in each group." }, { "field": "population", "quote": "all patients with deep neck abscesses treated at Dr Sardjito General Hospital" }, { "field": "intervention", "quote": "Participants in the intervention group received standard dressings in addition to honey dressings" }, { "field": "comparator", "quote": "those in the control group received standard dressings alone" }, { "field": "primaryOutcome", "quote": "Proinflammatory cytokines and growth factors, wound size, Bates-Jensen Wound Assessment Tools scoring, and quantitative bacterial colony identification will be all evaluated and assessed." }, { "field": "result", "quote": "This manuscript presents a study protocol for a randomized controlled trial investigating honey as a wound care modality in patients with deep neck space abscesses." } ] }, { "id": "pmid:40710718", "pmid": "40710718", "doi": "10.3390/gels11070557", "nctId": null, "pmcid": "PMC12294384", "title": "Composite HPMC-Gelatin Films Loaded with Cameroonian and Manuka Honeys Show Antibacterial and Functional Wound Dressing Properties", "firstAuthor": "Boateng", "multipleAuthors": true, "journal": "Gels", "year": 2025, "design": "lab", "n": null, "nField": "not-reported", "population": "not applicable - laboratory wound dressing film study, not human patients", "intervention": "honey-loaded hydrocolloid film (gelatin and HPMC) containing Cameroonian or Manuka honey", "comparator": "films with different honey concentrations (1% vs 5% w/v) and different honey sources compared to each other", "primaryOutcome": "film physical properties (tensile strength, stickiness, moisture handling) and antibacterial activity against wound bacteria", "result": "honey films showed increased antibacterial inhibition zones and changed physical properties with higher honey concentration, with similar performance between honey types", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a laboratory material-science study on films in vitro, not a clinical study on patients or wounds healing in the body.", "directness": "indirect", "limitations": "laboratory in-vitro study only; no human or animal wound healing tested; not related to anorectal surgery or clinical outcomes", "followUp": "", "plainFinding": "Lab test: honey film fights bacteria.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40710718/", "sourceText": "Antimicrobial resistance in infected chronic wounds present significant risk of complications (e.g., amputations, fatalities). This research aimed to formulate honey-loaded hydrocolloid film comprising gelatin and HPMC, for potential treatment of infected chronic wounds. Honeys from different sources (Cameroonian and Manuka) were used as the bioactive ingredients and their functional characteristics evaluated and compared. The formulated solvent cast films were functionally characterized for tensile, mucoadhesion and moisture handling properties. The morphology and physical characteristics of the films were also analyzed using FTIR, X-ray diffraction and scanning electron microscopy. Antibacterial susceptibility testing was performed to study the inhibition of Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus by honey components released from the films. The % elongation values (8.42-40.47%) increased, elastic modulus (30.74-0.62 Nmm) decreased, the stickiness (mucoadhesion) (0.9-1.9 N) increased, equilibrium water content (32.9-72.0%) and water vapor transmission rate (900-298 gm2 day-1) generally decreased, while zones of inhibition (2.4-6.5 mm) increased with increasing honey concentration for 1 and 5% w/v, respectively. The results generally showed similar performance for the different honeys and demonstrate the efficacy of honey-loaded hydrocolloid films as potential wound dressing against bacterial growth and potential treatment of infected chronic wounds.", "provenance": [ { "field": "population", "quote": "formulate honey-loaded hydrocolloid film comprising gelatin and HPMC, for potential treatment of infected chronic wounds" }, { "field": "intervention", "quote": "Honeys from different sources (Cameroonian and Manuka) were used as the bioactive ingredients" }, { "field": "comparator", "quote": "zones of inhibition (2.4-6.5 mm) increased with increasing honey concentration for 1 and 5% w/v, respectively" }, { "field": "primaryOutcome", "quote": "Antibacterial susceptibility testing was performed to study the inhibition of Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus by honey components released from the films" }, { "field": "result", "quote": "The results generally showed similar performance for the different honeys and demonstrate the efficacy of honey-loaded hydrocolloid films as potential wound dressing against bacterial growth and potential treatment of infected chronic wounds." } ] }, { "id": "pmid:40066391", "pmid": "40066391", "doi": "10.1007/s12070-024-05130-8", "nctId": null, "pmcid": "PMC11890483", "title": "A Study of Effect of Manuka Honey Healing in Post Operative Fess Surgery", "firstAuthor": "Jain", "multipleAuthors": true, "journal": "Indian J Otolaryngol Head Neck Surg", "year": 2025, "design": "case-series", "n": 50, "nField": "reported", "population": "patients who had surgery for sinus disease (post endoscopic sinus surgery)", "intervention": "manuka honey applied to the nose after surgery", "comparator": "no comparison group reported", "primaryOutcome": "time to heal of the nasal lining after surgery", "result": "median time to clean cavity, mucosal transition and complete healing was 14 days", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this was a small study of 50 patients with no comparison group, so it can't show whether honey actually sped healing versus no treatment", "directness": "indirect", "limitations": "no control or comparator group was described, and the study looked at sinus surgery, not anorectal surgery", "followUp": "", "plainFinding": "Faster nasal healing reported", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40066391/", "sourceText": "The aim of this study was to observe the effect of topical application of manuka honey in healing of nasal mucosa in Post Endoscopic Sinus Surgery. A total of 50 patients were selected and were operated for sinonasal diseases. Post operative after nasal pack removal manuka honey was applied. Post- operative healing was assessed and scoring was done. The present study was to evaluate and observe faster healing after application of Manuka honey. The median time to achieve clean cavity, mucosal transition and complete epithelialization was 14.0 (14.0-14.0) days. The present study concluded that application of manuka honey promotes faster healing of nasal cavity and lessens chances of postoperative infections.", "provenance": [ { "field": "n", "quote": "A total of 50 patients were selected" }, { "field": "population", "quote": "patients were selected and were operated for sinonasal diseases" }, { "field": "intervention", "quote": "Post operative after nasal pack removal manuka honey was applied" }, { "field": "comparator", "quote": "A total of 50 patients were selected and were operated for sinonasal diseases." }, { "field": "primaryOutcome", "quote": "The median time to achieve clean cavity, mucosal transition and complete epithelialization was 14.0 (14.0-14.0) days." }, { "field": "result", "quote": "The median time to achieve clean cavity, mucosal transition and complete epithelialization was 14.0 (14.0-14.0) days." } ] }, { "id": "pmid:40005964", "pmid": "40005964", "doi": "10.3390/ph18020149", "nctId": null, "pmcid": "PMC11858640", "title": "Topical Application of Manuka Honey for the Treatment of Non-Healing Venous Leg Ulcers", "firstAuthor": "Kucharzewski", "multipleAuthors": true, "journal": "Pharmaceuticals (Basel)", "year": 2025, "design": "rct", "n": 80, "nField": "reported", "population": "patients with chronic non-healing venous leg ulcers", "intervention": "topical Manuka honey application with compression bandage", "comparator": "antimicrobial calcium alginate wound dressing with silver", "primaryOutcome": "time to complete wound healing", "result": "ulcers healed in up to 7 weeks with Manuka honey versus up to 14 weeks with the silver dressing", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Although randomized, this is a small single study in leg ulcer patients, not anorectal surgery patients, with limited detail on blinding or statistical analysis.", "directness": "indirect", "limitations": "Abstract does not report blinding, statistical significance testing, or dropout rates.", "followUp": "up to 14 weeks", "plainFinding": "Faster healing than silver dressing.", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/40005964/", "sourceText": "Background/Objectives: Issues related to the chronic venous leg ulcer (VLU) treatment and prevention of recurrences remain the subject of research, but so too do common clinical problems in daily medical practice. Due to its medicinal properties, Manuka honey is increasingly used in the treatment of wounds of various origins. The aim of the study was to investigate the effectiveness of Manuka honey for the topical treatment of non-healing, chronic, venous leg ulcers. Methods: Eighty patients with chronic VLU participated in the study and were randomized into two equinumerous groups. In group 1, patients were treated with topical Manuka honey application and short stretch bandage compression, whereas, in group 2, antimicrobial calcium alginate wound dressing + Ag was used instead of Manuka honey. The efficacy of both treatment methods was compared. Results: The ulcerations in patients from group 1 have healed completely after up to seven weeks of therapy in all cases. In contrast, in all patients from group 2, the healing process was longer but completed successfully after up to 14 weeks of the therapy. The process of wound cleaning from microorganisms was also faster in group 1, as well as the reduction in ulcer area during treatment. Conclusions: It was found that the topical administration of Manuka honey may be a promising alternative to traditional methods of non-healing VLU treatment.", "provenance": [ { "field": "n", "quote": "Eighty patients with chronic VLU participated in the study" }, { "field": "population", "quote": "patients with chronic VLU participated in the study" }, { "field": "intervention", "quote": "patients were treated with topical Manuka honey application and short stretch bandage compression" }, { "field": "comparator", "quote": "antimicrobial calcium alginate wound dressing + Ag was used instead of Manuka honey" }, { "field": "primaryOutcome", "quote": "The aim of the study was to investigate the effectiveness of Manuka honey for the topical treatment of non-healing, chronic, venous leg ulcers." }, { "field": "result", "quote": "The ulcerations in patients from group 1 have healed completely after up to seven weeks of therapy in all cases. In contrast, in all patients from group 2, the healing process was longer but completed successfully after up to 14 weeks of the therapy." } ] }, { "id": "pmid:39840331", "pmid": "39840331", "doi": "10.3389/fvets.2024.1470528", "nctId": null, "pmcid": "PMC11746900", "title": "Case report: Surgical closure of a facial defect in an African wild dog (Lycaon pictus) utilizing a transpositional skin flap", "firstAuthor": "Brus", "multipleAuthors": true, "journal": "Front Vet Sci", "year": 2024, "design": "case-series", "n": 1, "nField": "reported", "population": "a zoo-housed African wild dog with a facial wound from suspected envenomation", "intervention": "topical manuka honey with bandaging, followed by surgical skin flap closure", "comparator": "none", "primaryOutcome": "wound healing and return to pack", "result": "wound developed healthy granulation tissue within 9 days and was then surgically closed with good cosmetic outcome and successful pack reintegration", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single animal case report, not a controlled study, so it cannot show whether the honey itself caused the improvement", "directness": "indirect", "limitations": "single case, no control group, species is a wild dog not a human surgical patient, honey combined with surgery and bandaging so individual effect unclear", "followUp": "9 days", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39840331/", "sourceText": "Veterinary intervention in zoological species can be complicated by species-specific social dynamics. African wild dogs are a pack species and removal or separation of an individual may disrupt established pack hierarchy resulting in conspecific aggression. Therefore, medical interventions that optimize a quick return to health are ideal to minimize the duration of absence from the pack. These principles were utilized for a three-year-old male intact zoo-housed African wild dog (AWD) that presented with an episode of severe, acute, right-sided facial swelling. Swelling initially responded to medical management, however 6 days later the facial swelling worsened. The AWD was anesthetized and required extensive debridement of necrotic tissue. The absence of deep bacteria on histopathologic evaluation and a negative bacterial culture was suggestive of envenomation. The resultant open wound was managed every other day with debridement and topical manuka honey covered with a tie-over bandage. Each wound therapy treatment required general anesthesia but resulted in a healthy granulation tissue bed 9 days following initial debridement. Rather than proceeding with second intention healing and continued bandage changes, a transpositional skin flap surgical procedure was performed and enabled full closure of the large skin defect with complete tissue apposition and a good cosmetic outcome. The surgery reduced the number of anesthetic events and time that would have been required for second intention healing of the defect, which enabled a more rapid and ultimately successful reintegration of this individual into the pack without any perceived changes to the hierarchical structure.", "provenance": [ { "field": "n", "quote": "a three-year-old male intact zoo-housed African wild dog" }, { "field": "population", "quote": "a three-year-old male intact zoo-housed African wild dog (AWD) that presented with an episode of severe, acute, right-sided facial swelling" }, { "field": "intervention", "quote": "The resultant open wound was managed every other day with debridement and topical manuka honey covered with a tie-over bandage." }, { "field": "comparator", "quote": "Rather than proceeding with second intention healing and continued bandage changes, a transpositional skin flap surgical procedure was performed" }, { "field": "primaryOutcome", "quote": "resulted in a healthy granulation tissue bed 9 days following initial debridement" }, { "field": "result", "quote": "resulted in a healthy granulation tissue bed 9 days following initial debridement" } ] }, { "id": "pmid:39800021", "pmid": "39800021", "doi": "10.1016/j.ijbiomac.2025.139753", "nctId": null, "pmcid": null, "title": "Investigating the efficacy of gellan gum hydrogel films infused with Acacia stingless bee honey in wound healing", "firstAuthor": "Mahmod", "multipleAuthors": true, "journal": "Int J Biol Macromol", "year": 2025, "design": "lab", "n": null, "nField": "not-reported", "population": "Lab-based study using mouse fibroblast cells (3T3-L1) and E. coli bacteria, not human patients", "intervention": "Gellan gum hydrogel films infused with acacia stingless bee honey at different concentrations (10%, 15%, 20%)", "comparator": "Gellan gum hydrogel films without honey or different honey concentrations compared to each other", "primaryOutcome": "Wound healing properties including cell migration, cell viability, and antibacterial activity in lab tests", "result": "The 20% honey formulation showed the highest wound closure rate, improved cell migration and proliferation, and no toxic effects on cells", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is an early-stage lab experiment on cells and bacteria, not people, so it cannot show whether this would help real wounds heal.", "directness": "indirect", "limitations": "This is in-vitro (lab dish) research only, uses a different honey type (acacia stingless bee honey, not manuka), and has not been tested in humans or animals with real wounds, let alone after anorectal surgery.", "followUp": "72 h", "plainFinding": "Helped cells heal in lab dish.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39800021/", "sourceText": "Effective wound healing requires biocompatible and functional wound dressings. This study explores the synergistic potential of gellan gum (GG), known for its exceptional gel-forming abilities, and acacia stingless bee honey (SBH), for its potent antioxidant properties, in developing advanced wound care solutions. GG hydrogel films incorporated with varying concentrations of SBH (v/v) at 10 % (GGSBH10), 15 % (GGSBH15), and 20 % (GGSBH20) were characterized. The incorporation of SBH into the GG matrix resulted in distinctive spectral peaks of ATR-FTIR associated with SBH, particularly evident in GGSBH20. Among the formulations, GGSBH20 demonstrated an impressive water vapor transmission rate of 1149 ± 11 g m-2 d-1 and a swelling ratio of 169 ± 7 %. Disk diffusion revealed that E. coli was susceptible to GGSBH. Cytotoxicity assessments (MTT and scratch assays) on 3 T3-L1 cells confirmed the biocompatibility of GGSBH, which showed no cytotoxic effects up to 72 h of incubation, and improved cell viability. Notably, GGSBH20 displayed the highest wound closure rate, significantly enhancing cell migration and proliferation. Overall, our findings underscore the promising healing properties of GG hydrogel films when enriched with acacia SBH, highlighting their potential as effective and innovative wound dressing materials.", "provenance": [ { "field": "population", "quote": "Cytotoxicity assessments (MTT and scratch assays) on 3 T3-L1 cells confirmed the biocompatibility of GGSBH" }, { "field": "intervention", "quote": "GG hydrogel films incorporated with varying concentrations of SBH (v/v) at 10 % (GGSBH10), 15 % (GGSBH15), and 20 % (GGSBH20) were characterized." }, { "field": "comparator", "quote": "Among the formulations, GGSBH20 demonstrated an impressive water vapor transmission rate" }, { "field": "primaryOutcome", "quote": "Notably, GGSBH20 displayed the highest wound closure rate, significantly enhancing cell migration and proliferation." }, { "field": "result", "quote": "Notably, GGSBH20 displayed the highest wound closure rate, significantly enhancing cell migration and proliferation." }, { "field": "followUp", "quote": "no cytotoxic effects up to 72 h of incubation" } ] }, { "id": "pmid:39788879", "pmid": "39788879", "doi": "10.25270/wmp.23119", "nctId": null, "pmcid": null, "title": "Expediting acute wound healing by integrating multiple therapeutic strategies: a case series", "firstAuthor": "Gallagher", "multipleAuthors": true, "journal": "Wound Manag Prev", "year": 2024, "design": "case-series", "n": 124, "nField": "reported", "population": "patients with acute traumatic wounds", "intervention": "combination wound therapy including hypochlorous acid cleanser, negative pressure therapy, collagen, silver, manuka honey, and/or foam dressings", "comparator": "none reported - single group, no comparison arm", "primaryOutcome": "time to wound healing", "result": "median healing time was 19 days with multimodal combination therapy", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small observational case series with no control group, and manuka honey was just one of several treatments used together, so its individual effect cannot be determined.", "directness": "indirect", "limitations": "No comparator group; manuka honey was combined with multiple other treatments (hypochlorous acid, negative pressure therapy, collagen, silver, foam dressings) so its individual contribution cannot be isolated; population was general acute wounds, not anorectal surgery patients.", "followUp": "", "plainFinding": "Can't isolate honey's effect.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39788879/", "sourceText": "BACKGROUND: Traumatic injuries have increased risks for infection and progression to difficult-to-heal wounds. Often, they are inadequately treated with single-purpose dressings. Involving wound care specialists allows for integrating various advanced wound treatments. The objective of this report was to assess if healing rates correlated with using unique combination therapies. METHODS: An observational, prospective analysis was performed, reviewing patients with acute wounds from admission until healed. Systematic assessments were standardized, employing T.I.M.E. (tissue, infection /inflammation, moisture balance, edge/periwound). Key outcomes included wound progression, dimensions, treatments, healing time, and health care utilization metrics. RESULTS: A total of 124 patients with acute wounds up to 1120 cm3 healed using multimodal therapy. Median time to wound specialist consultation was 2 days. It was determined that all patients were treated with a pure hypochlorous acid-based wound cleanser combined with negative pressure wound therapy, collagen, silver, manuka honey, and/or foam dressings. Median healing time was 19 days. Delays were associated with smoking, immunocompromise, and inability to obtain wound care supplies. CONCLUSIONS: Optimizing advanced therapeutic combinations with innovative dressings, including pHA and other beneficial components, has shown reduced health care utilization of acute wound patients by shortening healing time. The resulting decrease in dressing changes, follow-up appointments, and home care could increase patient satisfaction and improve outcomes.", "provenance": [ { "field": "n", "quote": "A total of 124 patients with acute wounds up to 1120 cm3 healed using multimodal therapy." }, { "field": "population", "quote": "Traumatic injuries have increased risks for infection and progression to difficult-to-heal wounds." }, { "field": "intervention", "quote": "all patients were treated with a pure hypochlorous acid-based wound cleanser combined with negative pressure wound therapy, collagen, silver, manuka honey, and/or foam dressings" }, { "field": "comparator", "quote": "An observational, prospective analysis was performed, reviewing patients with acute wounds from admission until healed." }, { "field": "primaryOutcome", "quote": "Key outcomes included wound progression, dimensions, treatments, healing time, and health care utilization metrics." }, { "field": "result", "quote": "Median healing time was 19 days." } ] }, { "id": "pmid:39690198", "pmid": "39690198", "doi": "10.1007/s00105-024-05442-4", "nctId": null, "pmcid": "PMC11711874", "title": "[Ulcers and diabetic foot : Modern and alternative treatment strategies]", "firstAuthor": "Tanasov", "multipleAuthors": true, "journal": "Dermatologie (Heidelb)", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with treatment-refractory diabetic foot ulcers", "intervention": "honey dressings (one of several alternative therapies discussed)", "comparator": "", "primaryOutcome": "healing of treatment-refractory diabetic foot ulcers", "result": "abstract only states honey dressings have been reported as used successfully, with no specific data given", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a narrative review that only mentions honey dressings in passing as a literature report, with no study details, numbers, or outcome data provided.", "directness": "indirect", "limitations": "abstract gives no details on study design, patient numbers, type of honey used, or specific outcomes for honey dressings; it is a general review of diabetic foot ulcer treatments, not a study of manuka honey or anorectal surgery.", "followUp": "", "plainFinding": "Honey mentioned, no data given", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39690198/", "sourceText": "Treatment of diabetic foot is challenging due to the complex pathophysiological mechanisms, various clinical manifestations, severe complications with considerable impairment of quality of life, and the need for special, individualized treatment strategies. Particularly in the case of diabetic foot ulcers, conventional therapies are not always effective, so new treatment strategies are needed. This review aims to present alternative therapies with current efficacy data for diabetic foot ulcers that may be suitable for treatment-refractory ulcers. Platelet-rich plasma and stem cells have regenerative and anti-inflammatory effects and show good results in the treatment of diabetic ulcers, while ozone therapy improves local circulation and antioxidant levels. Wearable devices could become crucial for the long-term monitoring of patients with diabetic foot as they allow early identification of ulcers or infections. There are also literature reports of alternative treatments (e.g., maggot debridement, honey dressings, acupuncture) that have been used successfully for treatment-refractory ulcers, demonstrating how diverse the management of the diabetic foot can be.", "provenance": [ { "field": "population", "quote": "treatment-refractory ulcers" }, { "field": "intervention", "quote": "honey dressings" }, { "field": "primaryOutcome", "quote": "diabetic foot ulcers that may be suitable for treatment-refractory ulcers" }, { "field": "result", "quote": "There are also literature reports of alternative treatments (e.g., maggot debridement, honey dressings, acupuncture) that have been used successfully for treatment-refractory ulcers" } ] }, { "id": "pmid:39676562", "pmid": "39676562", "doi": "10.1021/acsabm.4c01449", "nctId": null, "pmcid": null, "title": "Janus Films Wound Dressing Comprising Electrospun Gelatin/PCL Nanofibers and Gelatin/Honey/Curcumin Thawed Layer", "firstAuthor": "Kheradvar Kolour", "multipleAuthors": true, "journal": "ACS Appl Bio Mater", "year": 2024, "design": "animal", "n": null, "nField": "not-reported", "population": "wounds in an in vivo animal study (species not specified)", "intervention": "a bilayered wound dressing made of gelatin/PCL nanofiber film combined with a gelatin hydrogel containing honey and curcumin", "comparator": "a commercial wound dressing", "primaryOutcome": "wound healing, including wound closure, collagen production, tissue granulation, and re-epithelialization", "result": "the honey/curcumin bilayered dressing promoted wound closure, collagen production, tissue granulation, immune response, and re-epithelialization compared to the commercial dressing", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a small animal/lab study testing a combined honey-curcumin-nanofiber dressing without reporting sample size, so it cannot show whether honey itself caused the effect or support use in human wound care.", "directness": "indirect", "limitations": "No sample size reported, honey is combined with curcumin and synthetic nanofiber/hydrogel layers so honey's individual contribution is unclear, and this is an animal study not involving anorectal surgery patients.", "followUp": "", "plainFinding": "Honey-based dressing helped wounds heal (animals).", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39676562/", "sourceText": "A promising approach for wound treatment is using multilayer wound dressings that offer multifunctional properties. In this study, a bilayered electrospun/hydrogel gelatin-based scaffold integrated with honey and curcumin was developed to treat wounds under an in vivo study. The first layer consisted of an enzymatic cross-linked gelatin hydrogel containing honey and curcumin, which gelatin/PCL nanofibers reinforced. The physicochemical, mechanical, and biological properties of both layers were evaluated. Then, the bilayered wound dressing was compared to a commercial wound dressing in an in vivo study. The results showed that this strategy provided the wound dressing with a strength of 40 MPa, 70% elongation, 800% swelling rate, and 8 g/h/m2 water vapor permeability. Furthermore, MTT and histopathological staining demonstrated that the bilayered wound dressing promoted wound closure accelerated collagen production and tissue granulation, and promoted immune system response and re-epithelialization compared to other groups. The presence of a nanofibrous layer on the surface of the wound dressing facilitated its use, and the inclusion of honey and gelatin in the hydrogel layer prevented adhesion to the wound tissue and allowed for easy replacement without damaging the wound bed. Overall, the bilayered dressing with multifunctional properties holds great potential for developing wound dressings.", "provenance": [ { "field": "intervention", "quote": "a bilayered electrospun/hydrogel gelatin-based scaffold integrated with honey and curcumin was developed to treat wounds under an in vivo study" }, { "field": "comparator", "quote": "the bilayered wound dressing was compared to a commercial wound dressing in an in vivo study" }, { "field": "primaryOutcome", "quote": "MTT and histopathological staining demonstrated that the bilayered wound dressing promoted wound closure accelerated collagen production and tissue granulation, and promoted immune system response and re-epithelialization compared to other groups" }, { "field": "result", "quote": "the bilayered wound dressing promoted wound closure accelerated collagen production and tissue granulation, and promoted immune system response and re-epithelialization compared to other groups" }, { "field": "population", "quote": "compared to a commercial wound dressing in an in vivo study" } ] }, { "id": "pmid:39657741", "pmid": "39657741", "doi": "10.1021/acsabm.4c01212", "nctId": null, "pmcid": null, "title": "Glycyrrhizic Acid-Loaded Poloxamer and HPMC-Based In Situ Forming Gel of Acacia Honey for Improved Wound Dressing: Formulation Optimization and Characterization for Wound Treatment", "firstAuthor": "Jha", "multipleAuthors": true, "journal": "ACS Appl Bio Mater", "year": 2025, "design": "animal", "n": null, "nField": "not-reported", "population": "experimental animal models with wounds", "intervention": "in situ hydrogel", "comparator": "standard treatments", "primaryOutcome": "wound healing", "result": "complete wound closure within 15 days of treatment and accelerated development of the extracellular matrix", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is an early-stage animal and lab study of acacia honey, not manuka honey, and not in human anorectal surgery patients, so it gives only indirect, low-certainty evidence.", "directness": "indirect", "limitations": "Animal study only, no human trial, uses acacia honey combined with another compound rather than manuka honey alone, and participant/animal numbers are not reported.", "followUp": "15 days", "plainFinding": "Faster wound healing in animals.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39657741/", "sourceText": "The present study aims to formulate a stimuli-responsive in situ hydrogel system to codeliver acacia honey and glycyrrhizic acid for topical application that will aid in absorbing wound exudates, control microbial infestation, and produce angiogenic and antioxidant effects to accelerate wound healing. Therefore, both the natural active constituents were incorporated within an in situ hydrogel composed of poloxamer and hydroxypropyl methylcellulose (HPMC), where the concentrations of the polymers were optimized using Design-Expert software considering optimum values of the dependent variables, gelation temperature (34-37 °C), gelation time (<10 min), and the viscosity (2000-3500 cPs). The optimized formulation showed improved physicochemical properties such as mucoadhesiveness, porosity, swelling, and spreadability, which makes it suitable for wound application. Additionally, the in situ hydrogel exhibited potent in vitro and ex vivo antioxidant effects, in vitro antimicrobial activities, and ex ovo angiogenic effects. Furthermore, the optimized formulation was found to be nontoxic while tested in the HaCaT cell line and acute dermal irritation and corrosion study. The findings of the in vivo wound-healing studies in experimental animal models showed complete wound closure within 15 days of treatment and accelerated development of the extracellular matrix. In addition, the antioxidant, antimicrobial, angiogenic, and wound-healing properties of acacia honey and glycyrrhizic acid coloaded in situ hydrogel were also found to be promising when compared to the standard treatments. Overall, it can be concluded that the optimized stimuli-responsive in situ hydrogel containing two natural compounds could be an alternative to existing topical formulations for acute wounds.", "provenance": [ { "field": "population", "quote": "in vivo wound-healing studies in experimental animal models" }, { "field": "intervention", "quote": "codeliver acacia honey and glycyrrhizic acid for topical application" }, { "field": "comparator", "quote": "compared to the standard treatments" }, { "field": "primaryOutcome", "quote": "accelerate wound healing" }, { "field": "result", "quote": "complete wound closure within 15 days of treatment and accelerated development of the extracellular matrix" } ] }, { "id": "pmid:39508248", "pmid": "39508248", "doi": "10.1186/s12917-024-04358-4", "nctId": null, "pmcid": "PMC11539556", "title": "Autologous platelet-rich fibrin enhances skin wound healing in a feline trauma model", "firstAuthor": "Zhang", "multipleAuthors": true, "journal": "BMC Vet Res", "year": 2024, "design": "animal", "n": 18, "nField": "reported", "population": "Cats with experimentally created traumatic skin wounds", "intervention": "Platelet-rich fibrin (PRF) applied to the wound", "comparator": "Manuka honey applied as a positive control", "primaryOutcome": "Rate and quality of skin wound healing (healing rate, histology, growth factors, inflammation, collagen formation)", "result": "PRF-treated wounds healed comparably to manuka honey-treated wounds, both showing accelerated healing versus plain assessment", "resultDirection": "no-benefit", "quality": "very-low", "qualityWhy": "This is a very small animal (cat) experiment, not a human trial, so it offers only indirect, low-certainty evidence for people.", "directness": "indirect", "limitations": "Small number of animals per group (n=6), non-human species, and a trauma wound model rather than human surgical/anorectal wounds.", "followUp": "days 7, 14, 21, and 28", "plainFinding": "Honey matched PRF for healing", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39508248/", "sourceText": "Trauma is a common cause of cutaneous surgical disease with an increased risk of secondary infection in cat clinics. Platelet-rich fibrin (PRF), a platelet and leukocyte concentrate containing multiple cytokines and growth factors, is known to accelerate the healing of wounds. However, how PRF affects wound healing in the cat trauma model has not been fully investigated. The study aimed to examine the impact of PRF on skin wound healing in the cat trauma model. In this study, PRF from cats was successfully produced for our investigation. The models of feline trauma were effectively established. A total of 18 cats were randomly divided into 3 groups (n = 6): (1) Control group (CON); (2) PRF group; (3) Manuka honey group (MAN, as a positive control). Experiments were performed separately on days 7, 14, 21, and 28. Our results showed that PRF was a safe and efficient method of wound healing that did not influence the cat's body temperature, respiration rate, and heart rate (HR). PRF accelerated skin wound healing in the cat trauma model based on the rate and histological observation of wound healing. In addition, PRF promoted the production of growth factors and suppressed inflammation during wound healing. PRF accelerated wound healing by increasing the formation of collagen fibers, as shown by Masson-trichrome staining. The outcomes of the PRF and MAN groups were comparable. In conclusion, PRF improves the healing of skin wounds in cats by boosting the synthesis of growth factors, reducing inflammation, and enhancing the synthesis of collagen fibers.", "provenance": [ { "field": "population", "quote": "The models of feline trauma were effectively established." }, { "field": "population", "quote": "A total of 18 cats were randomly divided into 3 groups (n = 6)" }, { "field": "intervention", "quote": "Platelet-rich fibrin (PRF), a platelet and leukocyte concentrate containing multiple cytokines and growth factors, is known to accelerate the healing of wounds." }, { "field": "comparator", "quote": "Manuka honey group (MAN, as a positive control)" }, { "field": "primaryOutcome", "quote": "The study aimed to examine the impact of PRF on skin wound healing in the cat trauma model." }, { "field": "result", "quote": "The outcomes of the PRF and MAN groups were comparable." }, { "field": "n", "quote": "A total of 18 cats were randomly divided into 3 groups (n = 6)" }, { "field": "followUp", "quote": "Experiments were performed separately on days 7, 14, 21, and 28." } ] }, { "id": "pmid:39310249", "pmid": "39310249", "doi": "10.62347/RBJC6006", "nctId": null, "pmcid": "PMC11411175", "title": "Evaluation of pain associated with the application of burn dressings", "firstAuthor": "Kenney", "multipleAuthors": true, "journal": "Int J Burns Trauma", "year": 2024, "design": "retrospective", "n": null, "nField": "not-reported", "population": "patients with burn wounds receiving topical dressings", "intervention": "manuka honey dressing", "comparator": "other burn dressings (5% sulfamylon solution, negative-pressure wound therapy, silver sulfadiazine, silver nylon)", "primaryOutcome": "daily and maximum pain scores and opioid use during dressing care", "result": "Manuka honey had higher mean daily pain scores than silver sulfadiazine and lower opioid consumption than 5% SMS and NPWT only", "resultDirection": "mixed", "quality": "low", "qualityWhy": "It is a retrospective study without reported patient numbers or control for confounding factors, so its findings are weak evidence.", "directness": "indirect", "limitations": "Retrospective design; abstract calls for further studies with validated pain tools and clinically relevant endpoints.", "followUp": "", "plainFinding": "More pain, less opioid use.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39310249/", "sourceText": "INTRODUCTION: Topical wound care after burn injury has revolutionized burn care. Dressings and topical solutions provide broad-spectrum antimicrobial coverage to prevent wound infection, be easy to apply and remove, and promote wound healing. A wide variety of dressings are available for providers to choose from based on wound characteristics. An additional factor to consider when making that decision is any pain associated with applying the dressing and frequency of dressing changes. METHODOLOGY: This retrospective study aimed to examine the daily and maximum pain reported by patients and daily opioid consumption to determine if there are any differences among commonly used dressings including 5% sulfamylon solution (SMS), manuka honey, negative-pressure wound therapy (NPWT), silver sulfadiazine, and silver nylon. RESULTS: This study demonstrated that silver sulfadiazine had lower mean daily pain scores compared only to manuka honey as well as lower maximum scores when compared to all other dressings except silver nylon. Furthermore, the choice of dressing did not have an overwhelming effect on the amount of opioids consumed by patients during their hospital stay with manuka honey having less opioid consumption when compared to only 5% SMS and NPWT only. CONCULSION: Further studies are needed with additional validated pain assessment tools and clinically relevant endpoints to fully elucidate the impact of burn dressings and other topical wound care options on pain.", "provenance": [ { "field": "population", "quote": "the daily and maximum pain reported by patients and daily opioid consumption" }, { "field": "intervention", "quote": "manuka honey" }, { "field": "comparator", "quote": "5% sulfamylon solution (SMS), manuka honey, negative-pressure wound therapy (NPWT), silver sulfadiazine, and silver nylon" }, { "field": "primaryOutcome", "quote": "the daily and maximum pain reported by patients and daily opioid consumption" }, { "field": "result", "quote": "silver sulfadiazine had lower mean daily pain scores compared only to manuka honey as well as lower maximum scores when compared to all other dressings except silver nylon. Furthermore, the choice of dressing did not have an overwhelming effect on the amount of opioids consumed by patients during their hospital stay with manuka honey having less opioid consumption when compared to only 5% SMS and NPWT only." } ] }, { "id": "pmid:39237556", "pmid": "39237556", "doi": "10.1038/s41598-024-71466-4", "nctId": null, "pmcid": "PMC11377730", "title": "Synergistic nanocoating with layer-by-layer functionalized PCL membranes enhanced by manuka honey and essential oils for advanced wound healing", "firstAuthor": "Gallo", "multipleAuthors": true, "journal": "Sci Rep", "year": 2024, "design": "lab", "n": null, "nField": "not-reported", "population": "No human or animal patients; laboratory testing with fibroblast cells and bacterial strains", "intervention": "Electrospun PCL membranes coated with chitosan and manuka honey plus essential oil nanoemulsions (Layer-by-Layer coating)", "comparator": "Different coating compositions (with and without cinnamon essential oil nanoemulsion)", "primaryOutcome": "Membrane characterization, biocompatibility, wound-healing gene expression, and antibacterial activity", "result": "Coated membranes showed biocompatibility, expression of healing-related genes (VEGF, COL1, TGF-β1), and strong antibacterial activity against S. aureus and P. aeruginosa, with cinnamon oil enhancing bacterial inhibition", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is an early-stage lab experiment on cells and bacteria, not a study in humans or animals with wounds, so it cannot show whether this helps real patients heal.", "directness": "indirect", "limitations": "No animal or human testing; only in-vitro cell and bacterial assays described", "followUp": "", "plainFinding": "Lab coating shows wound-healing promise, untested in patients.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39237556/", "sourceText": "Chronic wounds represent a significant global health concern, statistically impacting 1-2% of the population in developed countries throughout their lifetimes. These wounds cause considerable discomfort for patients and necessitate substantial expenditures of time and resources for treatment. Among the emerging therapeutic approaches, medicated dressings incorporating bioactive molecules, including natural compounds, are particularly promising. Hence, the objective of this study was to develop novel antimicrobial dressings for wound treatment. Specifically, polycaprolactone membranes were manufactured using the electrospinning technique and subsequently coated with natural polyelectrolytes (chitosan as a polycation and a mixture of manuka honey with essential oils nanoemulsions as a polyanion) employing the Layer-by-Layer assembly technique. Physico-chemical and morphological characterization was conducted through QCM-D, FTIR-ATR, XPS, and SEM analyses. The results from SEM and QCM-D demonstrated successful layer deposition and coating formation. Furthermore, FTIR-ATR and XPS analyses distinguished among different coating compositions. The coated membranes were tested in the presence of fibroblast cells, demonstrating biocompatibility and expression of genes coding for VEGF, COL1, and TGF-β1, which are associated with the healing process (assessed through RT-qPCR analysis). Finally, the membranes exhibited excellent antibacterial activity against both Staphylococcus aureus and Pseudomonas aeruginosa, with higher bacterial strain inhibition observed when cinnamon essential oil nanoemulsion was incorporated. Taken together, these results demonstrate the potential application of nanocoated membranes for biomedical applications, such as wound healing.", "provenance": [ { "field": "population", "quote": "The coated membranes were tested in the presence of fibroblast cells" }, { "field": "intervention", "quote": "polycaprolactone membranes were manufactured using the electrospinning technique and subsequently coated with natural polyelectrolytes (chitosan as a polycation and a mixture of manuka honey with essential oils nanoemulsions as a polyanion) employing the Layer-by-Layer assembly technique" }, { "field": "comparator", "quote": "higher bacterial strain inhibition observed when cinnamon essential oil nanoemulsion was incorporated" }, { "field": "primaryOutcome", "quote": "demonstrating biocompatibility and expression of genes coding for VEGF, COL1, and TGF-β1, which are associated with the healing process" }, { "field": "result", "quote": "the membranes exhibited excellent antibacterial activity against both Staphylococcus aureus and Pseudomonas aeruginosa, with higher bacterial strain inhibition observed when cinnamon essential oil nanoemulsion was incorporated" } ] }, { "id": "pmid:39211979", "pmid": "39211979", "doi": "10.1111/iwj.70038", "nctId": null, "pmcid": "PMC11362661", "title": "Outcomes of a honey and olive oil-based dressing material on wounds of women that have had a caesarean section in south-western Uganda", "firstAuthor": "Ngonzi", "multipleAuthors": true, "journal": "Int Wound J", "year": 2024, "design": "case-series", "n": 25, "nField": "reported", "population": "women who had caesarean section births in south-western Uganda", "intervention": "honey and olive oil-based wound dressing (I-Dress)", "comparator": "none (no comparison group)", "primaryOutcome": "time taken for the wound to heal", "result": "No wound induration or dehiscence in any patient; 13% had wound discharge; average healing time 2.2 days", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a small uncontrolled case series with no comparison group, so it cannot show whether the dressing worked better than anything else.", "directness": "indirect", "limitations": "No control or comparator group; abstract does not mention blinding or randomization; this is a different population (caesarean section wounds) than anorectal surgery wounds.", "followUp": "2.2 (±0.7) days", "plainFinding": "Faster healing, no complications seen.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39211979/", "sourceText": "Postpartum sepsis following caesarean sections among women in Uganda remains a risk. However, erratic supplies of standard dressing material make the risk a reality. Alternative wound dressing materials, therefore, remain a viable option. This study examined the outcome of a honey and olive oil-based dressing material on caesarean section wound healing. Using the Uganda Industrial Research Institute (UIRI), the study team created I-Dress, a wound dressing made of honey and olive oil. A case-series study was conducted on 25 women who received I-Dress following caesarean births at three health facilities in south-west Uganda. Vital signs (temperature, blood pressure, and heart rate) were measured, along with wound induration, dehiscence, and discharge. The primary outcome was the length of time it took for the wound to heal. The average age of the women who received I-Dress was 27.5 (±4.8) years. Following the application of I-Dress, all of the women (100%) had no wound induration or dehiscence, with only two (13%) experiencing wound discharge. The vast majority of the women (88%) had never had a Caesarean section before. The mean time required for wound healing was 2.2 (±0.7) days. The findings indicate that honey and olive oil-based dressings improve Caesarean section wound healing in terms of wound induration, dehiscence, and time to healing. These dressing materials can therefore supplement the standard dressing materials, especially in resource-constrained settings.", "provenance": [ { "field": "n", "quote": "A case-series study was conducted on 25 women who received I-Dress following caesarean births at three health facilities in south-west Uganda." }, { "field": "population", "quote": "25 women who received I-Dress following caesarean births at three health facilities in south-west Uganda" }, { "field": "intervention", "quote": "the study team created I-Dress, a wound dressing made of honey and olive oil" }, { "field": "comparator", "quote": "A case-series study was conducted on 25 women who received I-Dress following caesarean births at three health facilities in south-west Uganda." }, { "field": "primaryOutcome", "quote": "The primary outcome was the length of time it took for the wound to heal." }, { "field": "result", "quote": "all of the women (100%) had no wound induration or dehiscence, with only two (13%) experiencing wound discharge" }, { "field": "result", "quote": "The mean time required for wound healing was 2.2 (±0.7) days." }, { "field": "followUp", "quote": "The mean time required for wound healing was 2.2 (±0.7) days." } ] }, { "id": "pmid:39203434", "pmid": "39203434", "doi": "10.3390/microorganisms12081593", "nctId": null, "pmcid": "PMC11356504", "title": "The Potential of Fish Oil Components and Manuka Honey in Tackling Chronic Wound Treatment", "firstAuthor": "Clare", "multipleAuthors": true, "journal": "Microorganisms", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with chronic wounds", "intervention": "manuka honey (and fish oil fatty acids) as topical treatment", "comparator": "no comparator described", "primaryOutcome": "wound infection control and wound healing/closure", "result": "the abstract discusses the potential of these substances but reports no measured outcome or effect size", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review discussing potential uses of manuka honey, not a study that tested it on patients, so it cannot show whether it actually works.", "directness": "indirect", "limitations": "No original patient data, no comparison group, and no mention of anorectal surgery; it is a review of general concepts about antimicrobial and wound-healing potential.", "followUp": "", "plainFinding": "Discusses potential, no outcome data", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39203434/", "sourceText": "Chronic wounds are becoming an increasing burden on healthcare services, as they have extended healing times and are susceptible to infection, with many failing to heal, which can lead ultimately to amputation. Due to the additional rise in antimicrobial resistance and emergence of difficult-to-treat Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. (ESKAPE pathogens), novel treatments will soon be required asides from traditional antibiotics. Many natural substances have been identified as having the potential to aid in both preventing infection and increasing the speed of wound closure processes. Manuka honey is already in some cases used as a topical treatment in the form of ointments, which in conjunction with dressings and fish skin grafts are an existing US Food and Drug Administration-approved treatment option. These existing treatment options indicate that fatty acids from fish oil and manuka honey are well tolerated by the body, and if the active components of the treatments were better understood, they could make valuable additions to topical treatment options. This review considers two prominent natural substances with established manufacturing and global distribution-marine based fatty acids (including their metabolites) and manuka honey-their function as antimicrobials and how they can aid in wound repair, two important aspects leading to resolution of chronic wounds.", "provenance": [ { "field": "population", "quote": "Chronic wounds are becoming an increasing burden on healthcare services" }, { "field": "intervention", "quote": "Manuka honey is already in some cases used as a topical treatment in the form of ointments" }, { "field": "comparator", "quote": "This review considers two prominent natural substances with established manufacturing and global distribution-marine based fatty acids (including their metabolites) and manuka honey" }, { "field": "primaryOutcome", "quote": "their function as antimicrobials and how they can aid in wound repair, two important aspects leading to resolution of chronic wounds" }, { "field": "result", "quote": "if the active components of the treatments were better understood, they could make valuable additions to topical treatment options" } ] }, { "id": "pmid:39137253", "pmid": "39137253", "doi": "10.12968/jowc.2022.0020", "nctId": null, "pmcid": null, "title": "Effect of honey and povidone-iodine on acute laceration wound healing: a pilot randomised controlled trial study", "firstAuthor": "Suryadinata", "multipleAuthors": true, "journal": "J Wound Care", "year": 2024, "design": "rct", "n": 35, "nField": "reported", "population": "patients with acute laceration wounds (cuts), mostly young adults, treated in Indonesia", "intervention": "honey as a wound dressing", "comparator": "povidone-iodine or paraffin gauze dressing", "primaryOutcome": "time for the wound to heal", "result": "no statistically significant difference in healing time between honey, povidone-iodine, and paraffin groups, though honey had lower cost and fewer adverse events", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "this is a small pilot trial with only about a dozen patients per group and no significant statistical difference found, so it cannot reliably show whether honey works better.", "directness": "indirect", "limitations": "small pilot study, single-blind, one patient lost to follow-up, and the honey type used was not specified as manuka honey; population was acute lacerations, not anorectal surgery wounds", "followUp": "", "plainFinding": "Honey healed as fast as alternatives.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39137253/", "sourceText": "OBJECTIVE: Acute laceration wound (ALW) is one of the most common injuries in Indonesia with potential significant morbidities. In rural areas, povidone-iodine and honey are commonly used as wound dressings. This study aimed to identify the effectiveness of honey compared to paraffin gauze and the commonly used povidone-iodine in improving ALW healing time. METHOD: This study was a single-blind, pilot randomised controlled trial (RCT) with three intervention groups (honey, povidone-iodine, and paraffin). The outcomes were wound healing time, slow healing, secondary healing, signs of infection, wound dehiscence, oedema, maceration, necrosis, exudate and cost. RESULTS: A total of 35 patients (male to female ratio: 4:1), with a mean age of 22.5 (range: 6-47) years, were included and randomised to treatment groups using predetermined randomisation according to wound location and wound dressing selection: honey group, n=12; povidone-iodine group, n=11; paraffin group, n=12 with one patient lost to follow-up. All groups achieved timely healing, with a mean healing time of 9.45±5.31 days and 11.09±5.14 days for the povidone-iodine and paraffin groups, respectively, and a median healing time of 10 (3-19) days for the honey group (p>0.05). More wounds in the honey group achieved healing in ≤10 days compared with the other groups. Both povidone-iodine and honey groups had fewer adverse events, with the latter having the lowest cost. CONCLUSION: In this study, honey was clinically effective in accelerating healing time with a lower cost compared to paraffin, and was comparable to povidone-iodine. Future RCTs with a larger sample size should be pursued to determine honey's role in ALW treatment.", "provenance": [ { "field": "n", "quote": "A total of 35 patients (male to female ratio: 4:1), with a mean age of 22.5 (range: 6-47) years, were included" }, { "field": "population", "quote": "Acute laceration wound (ALW) is one of the most common injuries in Indonesia" }, { "field": "intervention", "quote": "honey group, n=12" }, { "field": "comparator", "quote": "povidone-iodine group, n=11; paraffin group, n=12" }, { "field": "primaryOutcome", "quote": "The outcomes were wound healing time, slow healing, secondary healing, signs of infection, wound dehiscence, oedema, maceration, necrosis, exudate and cost." }, { "field": "result", "quote": "a median healing time of 10 (3-19) days for the honey group (p>0.05)" } ] }, { "id": "pmid:39125335", "pmid": "39125335", "doi": "10.3390/nu16152455", "nctId": null, "pmcid": "PMC11314015", "title": "Efficacy and Safety of Honey Dressings in the Management of Chronic Wounds: An Updated Systematic Review and Meta-Analysis", "firstAuthor": "Tang", "multipleAuthors": true, "journal": "Nutrients", "year": 2024, "design": "meta-analysis", "n": 906, "nField": "reported", "population": "people with chronic wounds", "intervention": "honey dressings", "comparator": "standard wound care (as used in included studies)", "primaryOutcome": "wound healing time and percentage of wound healed", "result": "faster healing time and greater percentage healed with honey, but no significant difference in healing rate, bacteria clearance time, or hospital stay", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "the authors themselves rate the evidence as very low quality due to risk of bias, inconsistent results across studies, and possible publication bias", "directness": "indirect", "limitations": "very low quality evidence due to risk of bias, inconsistency, and publication bias; studies are about chronic wounds in general, not specifically anorectal surgery or manuka honey", "followUp": "", "plainFinding": "Faster healing, but weak evidence", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39125335/", "sourceText": "Chronic wounds impose a substantial economic burden on healthcare systems and result in decreased productivity. Honey possesses diverse properties, rendering it a promising, cost-effective, and efficacious intervention strategy for the management of chronic wounds. However, the findings are controversial. We have presented an updated and comprehensive systematic review and meta-analysis to evaluate the efficacy and safety of honey dressings in the management of chronic wounds. Nine electronic databases were systematically searched to identify relevant studies published prior to 22 March 2024. A total of eight studies, including 906 individuals that met the inclusion criteria, were incorporated. The findings demonstrated a significant acceleration in wound healing time with honey dressings (MD = -17.13, 95% CI -26.37 to -7.89, p = 0.0003) and an increase in the percentage of wound healing (MD = 18.31, 95% CI 8.86 to 27.76, p = 0.0001). No statistically significant differences were observed in the healing rate (RR = 2.00, 95% CI 0.78 to 5.10, p = 0.15), clearance time of bacteria (MD = -11.36, 95% CI: -25.91 to 3.18, p = 0.13) and hospital stay duration. Honey may decrease the VAS score but may increase the incidence of painful discomfort during treatment. The topical application of honey is an effective therapeutic approach for managing chronic wounds, but the quality of the evidence was very low due to the quality of risk of bias, inconsistency, and publication bias, highlighting the necessity for larger-scale studies with adequately powered RCTs to ensure the safety and efficacy of honey dressings in chronic wound healing.", "provenance": [ { "field": "n", "quote": "A total of eight studies, including 906 individuals that met the inclusion criteria, were incorporated." }, { "field": "population", "quote": "the management of chronic wounds" }, { "field": "intervention", "quote": "honey dressings" }, { "field": "comparator", "quote": "evaluate the efficacy and safety of honey dressings in the management of chronic wounds" }, { "field": "primaryOutcome", "quote": "a significant acceleration in wound healing time with honey dressings (MD = -17.13, 95% CI -26.37 to -7.89, p = 0.0003) and an increase in the percentage of wound healing (MD = 18.31, 95% CI 8.86 to 27.76, p = 0.0001)" }, { "field": "result", "quote": "No statistically significant differences were observed in the healing rate (RR = 2.00, 95% CI 0.78 to 5.10, p = 0.15), clearance time of bacteria (MD = -11.36, 95% CI: -25.91 to 3.18, p = 0.13) and hospital stay duration." }, { "field": "qualityWhy", "quote": "the quality of the evidence was very low due to the quality of risk of bias, inconsistency, and publication bias" } ] }, { "id": "pmid:39103063", "pmid": "39103063", "doi": "10.1016/j.ijpharm.2024.124553", "nctId": null, "pmcid": null, "title": "A Natural deep eutectic solvent as an effective material for dual debridement and antibiofilm effects in chronic wound treatment", "firstAuthor": "Map Schuh", "multipleAuthors": true, "journal": "Int J Pharm", "year": 2024, "design": "lab", "n": null, "nField": "not-reported", "population": "people with leg ulcers, plus mice with diabetic wounds and lab/ex vivo skin samples", "intervention": "a new debriding material (BU) made from urea and betaine", "comparator": "medical honey and an antiseptic (PHMB-Betaine)", "primaryOutcome": "ability to remove dead tissue, reduce bacterial/biofilm load, and shrink wound size", "result": "the new BU material reduced bacterial load and wound area more than honey did, in leg ulcers", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is mainly a preclinical study (lab, ex vivo, and animal) with only a loosely described clinical portion, no patient numbers, and no mention of randomization or blinding.", "directness": "indirect", "limitations": "no participant numbers are given, the clinical evaluation is not described as randomized or controlled, and honey here is used only as a comparator to a different experimental material, not as the main treatment being tested.", "followUp": "", "plainFinding": "New material beat honey, not tested alone.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39103063/", "sourceText": "In chronic wound treatment, the debridement of devitalized tissue and the eradication of the biofilm must balance aggressiveness with care to protect regenerating tissues. In this study, urea, a potent chaotropic molecule, was modulated through the formation of a Natural Deep Eutectic Solvent (NADES) with betaine to develop a new debriding material (BU) suitable for application into injured dermal tissues. To evaluate BU's debriding capacity, along with its antibiofilm effect and biocompatibility, pre-clinical to clinical methods were employed. In vitro determinations using artificial and clinical slough samples indicate that BU has a high debriding capacity. Additionally, BU's de-structuring effects lead to a strong antibiofilm capability, demonstrated by a reduced bacterial load compared to the antiseptic PHMB-Betaine or medical honey, evaluated in artificial slough and ex vivo human skin. Furthermore, BU's efficacy was evaluated in a murine model of diabetic wound, demonstrating significant effects on debriding and antibiofilm capacity, similar to those observed in PHMB-Betaine and medical honey-treated animals. Finally, BU was clinically evaluated in leg ulcers, showing superiority in reduction of bacterial load and wound area compared to honey, with no adverse effects. Thus, BU represents a simple and non-biocidal option that could contributes to chronic wound care.", "provenance": [ { "field": "population", "quote": "evaluated in artificial slough and ex vivo human skin" }, { "field": "population", "quote": "BU was clinically evaluated in leg ulcers" }, { "field": "intervention", "quote": "a new debriding material (BU) suitable for application into injured dermal tissues" }, { "field": "comparator", "quote": "compared to the antiseptic PHMB-Betaine or medical honey" }, { "field": "primaryOutcome", "quote": "To evaluate BU's debriding capacity, along with its antibiofilm effect and biocompatibility" }, { "field": "result", "quote": "showing superiority in reduction of bacterial load and wound area compared to honey, with no adverse effects" } ] }, { "id": "pmid:38996893", "pmid": "38996893", "doi": "10.1016/j.ijbiomac.2024.133809", "nctId": null, "pmcid": null, "title": "Production and performance evaluation of chitosan/collagen/honey nanofibrous membranes for wound dressing applications", "firstAuthor": "de la Mora-López", "multipleAuthors": true, "journal": "Int J Biol Macromol", "year": 2024, "design": "lab", "n": null, "nField": "not-reported", "population": "Laboratory test using bacterial cultures and human skin cells (fibroblasts and keratinocytes), not patients", "intervention": "Nanofiber wound dressing membranes made of chitosan, collagen and honey at different honey concentrations (5%, 10%, 15%)", "comparator": "Membranes without honey (0% honey, PCH and PCHC)", "primaryOutcome": "Antibacterial effect against bacteria and biocompatibility (toxicity) with skin cells", "result": "Honey improved antibacterial efficiency and the membranes were not toxic to skin cells", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a lab-only test on cells and bacteria in dishes, not on real wounds or patients, so it cannot show whether honey actually helps wounds heal in people.", "directness": "indirect", "limitations": "In vitro study only; no human or animal wound testing; honey type not specified as manuka; no participant numbers as this is not a clinical study", "followUp": "", "plainFinding": "Lab test: honey boosted antibacterial dressing performance.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38996893/", "sourceText": "Persistent bacterial infections are the leading risk factor that complicates the healing of chronic wounds. In this work, we formulate mixtures of polyvinyl alcohol (P), chitosan (CH), collagen (C), and honey (H) to produce nanofibrous membranes with healing properties. The honey effect at concentrations of 0 % (PCH and PCHC), 5 % (PCHC-5H), 10 % (PCHC-10H), and 15 % (PCHC-15H) on the physicochemical, antibacterial, and biological properties of the developed nanofibers was investigated. Morphological analysis by SEM demonstrated that PCH and PCHC nanofibers had a uniform and homogeneous distribution on their surfaces. However, the increase in honey content increased the fiber diameter (118.11-420.10) and drastically reduced the porosity of the membranes (15.79-92.62 nm). The addition of honey reduces the water vapor transmission rate (WVTR) and the adsorption properties of the membranes. Mechanical tests revealed that nanofibers were more flexible and elastic when honey was added, specifically the PCHC-15H nanofibers with the lowest modulus of elasticity (15 MPa) and the highest elongation at break (220 %). Also, honey significantly improved the antibacterial efficiency of the nanofibers, mainly PCHC-15H nanofibers, which presented the best bacterial reduction rates against Staphylococcus aureus (59.84 %), Pseudomonas aeruginosa (47.27 %), Escherichia coli (65.07 %), and Listeria monocytogenes (49.58 %). In vitro tests with cell cultures suggest that nanofibers were not cytotoxic and exhibited excellent biocompatibility with human fibroblasts (HFb) and keratinocytes (HaCaT), since all treatments showed higher or similar cell viability as opposed to the cell control. Based on the findings, PVA-chitosan-collagen-honey nanofibrous membranes have promise as an antibacterial dressing substitute.", "provenance": [ { "field": "intervention", "quote": "we formulate mixtures of polyvinyl alcohol (P), chitosan (CH), collagen (C), and honey (H) to produce nanofibrous membranes with healing properties" }, { "field": "comparator", "quote": "The honey effect at concentrations of 0 % (PCH and PCHC), 5 % (PCHC-5H), 10 % (PCHC-10H), and 15 % (PCHC-15H)" }, { "field": "primaryOutcome", "quote": "honey significantly improved the antibacterial efficiency of the nanofibers" }, { "field": "result", "quote": "honey significantly improved the antibacterial efficiency of the nanofibers, mainly PCHC-15H nanofibers, which presented the best bacterial reduction rates against Staphylococcus aureus (59.84 %), Pseudomonas aeruginosa (47.27 %), Escherichia coli (65.07 %), and Listeria monocytogenes (49.58 %)" }, { "field": "result", "quote": "nanofibers were not cytotoxic and exhibited excellent biocompatibility with human fibroblasts (HFb) and keratinocytes (HaCaT)" }, { "field": "population", "quote": "In vitro tests with cell cultures" } ] }, { "id": "pmid:38864979", "pmid": "38864979", "doi": "10.1007/s00592-024-02320-2", "nctId": null, "pmcid": null, "title": "Effectiveness of different advanced wound dressings versus standard of care for the management of diabetic foot ulcers: a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome", "firstAuthor": "Monami", "multipleAuthors": true, "journal": "Acta Diabetol", "year": 2024, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people with diabetic foot ulcers", "intervention": "advanced wound dressings, including honey-impregnated dressings among other types", "comparator": "standard of care or placebo dressings", "primaryOutcome": "rate of ulcer healing", "result": "Advanced dressings as a group had higher healing rates and shorter time to healing, though the healing-rate odds ratio itself was not statistically significant", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "The abstract itself rates the evidence for the main healing outcome as moderate, and the result for honey dressings specifically is lumped together with many other dressing types rather than reported alone.", "directness": "indirect", "limitations": "Honey-impregnated dressings were only one of many dressing types pooled together, so no honey-specific effect size is given; the main healing-rate result (OR 1.50 [0.80, 2.79], p=0.20) was not statistically significant despite being described as significant in the text.", "followUp": "", "plainFinding": "Advanced dressings, honey included, sped healing a bit.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38864979/", "sourceText": "AIM: to assess the effects of advanced wound dressings (AWD) commonly used in the treatment of predominantly neuropathic diabetic foot ulcers (DFU) The present meta-analysis was designed to support the development of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome (DFS). METHODS: A Medline and Embase search were performed up to April 1st, 2024 collecting all RCTs including diabetic patients or reporting subgroup analyses on diabetic patients with DFU comparing AWD with placebo/standard of care (SoC), with a duration of at least 12 weeks. Prespecified endpoints were: ulcer healing (principal), time-to-healing, frequency of dressings change, major and minor amputation, pain, and all-cause mortality. AWD assessed were: alginates; foam, hydrocolloids, hydrogels, hyaluronic acid, hemoglobin spray, silver-impregnated, sucrose octasulfate-impregnated, honey-impregnated, micro-organism-binding, and protease-modulating matrix dressings. Mantel-Haenzel Odds ratios and 95% confidence intervals (MH-OR, 95% CIs) were either calculated or extracted directly from the publications. Weighted mean differences (WMD) and 95% CIs were calculated for continuous variables. RESULTS: Fifteen studies fulfilled all inclusion criteria. Participants treated with AWD had a significantly higher ulcer healing rate and shorter time-to-healing in comparison with SoC/placebo (MH-OR 1.50 [0.80, 2.79], p = 0.20 and WMD:: - 24.38 [- 42.90, - 5.86] days, p = 0.010). No other significant effect on the above reported prespecified endpoints were observed. For the primary endpoint, the quality of evidence was rated as \"moderate\". CONCLUSIONS: In conclusion, AWD, particularly sucrose-octasulfate, hydrogels, hyaluronic acid, and honey dressings, can actively promote wound healing and shortening time-to-healing in patients with DFU.", "provenance": [ { "field": "population", "quote": "collecting all RCTs including diabetic patients or reporting subgroup analyses on diabetic patients with DFU" }, { "field": "intervention", "quote": "AWD assessed were: alginates; foam, hydrocolloids, hydrogels, hyaluronic acid, hemoglobin spray, silver-impregnated, sucrose octasulfate-impregnated, honey-impregnated, micro-organism-binding, and protease-modulating matrix dressings." }, { "field": "comparator", "quote": "comparing AWD with placebo/standard of care (SoC)" }, { "field": "primaryOutcome", "quote": "Prespecified endpoints were: ulcer healing (principal), time-to-healing, frequency of dressings change, major and minor amputation, pain, and all-cause mortality." }, { "field": "result", "quote": "Participants treated with AWD had a significantly higher ulcer healing rate and shorter time-to-healing in comparison with SoC/placebo (MH-OR 1.50 [0.80, 2.79], p = 0.20 and WMD:: - 24.38 [- 42.90, - 5.86] days, p = 0.010)." }, { "field": "quality", "quote": "For the primary endpoint, the quality of evidence was rated as \"moderate\"." } ] }, { "id": "pmid:38817411", "pmid": "38817411", "doi": "10.12688/f1000research.134011.2", "nctId": null, "pmcid": "PMC11137484", "title": "Turmeric extract gel and honey in post-cesarean section wound healing: A preliminary study", "firstAuthor": "Nilawati Usman", "multipleAuthors": true, "journal": "F1000Res", "year": 2023, "design": "animal", "n": 56, "nField": "reported", "population": "Female white rats after cesarean section surgery", "intervention": "Trigona honey or turmeric extract gel applied to wound", "comparator": "Control group (no treatment) and comparisons between honey/turmeric groups", "primaryOutcome": "Wound healing speed (redness, swelling, bruising, granulation tissue) measured by Reeda Scale", "result": "Trigona honey applied twice daily healed wounds fastest, by day 9, better than turmeric gel or control", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is an animal study in rats, not humans, so it cannot reliably predict effects in people.", "directness": "indirect", "limitations": "Animal study in rats, not manuka honey specifically, and not anorectal surgery; small subgroups", "followUp": "15 days", "plainFinding": "Faster wound healing in rats with honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38817411/", "sourceText": "BACKGROUND: Delivery by cesarean section (SC) increases the risk of a surgical site infection (SSI). Therapy from health services and complementary therapy reduce the risk of infection and accelerate the wound-healing process. This study compared wound healing after SC with a turmeric extract gel and original Trigona honey. METHODS: Female white rats ( Rattus novergicus) with pre- and post-testing and a control group were included in this experiment, which was conducted in June-July 2022. The test animals were 56 female white rats, 2-4 months old, weighing 150-350 g. The treatment group was divided into three subgroups with application of 50% and 75% turmeric extract gel and Trigona honey. The turmeric was given twice daily, and the honey was divided into two applications of twice a day and once a day. Wounds were assessed using the Reeda Scale. RESULTS: The fastest wound healing occurred in the group given Trigona honey twice daily. Redness, ecchymosis, and edema disappeared in this group on day 9 (score 0), and granulation tissue formed on day 9. The group that was administered 50% and 75% turmeric gel extract and Trigona honey once a day healed by days 12 and 15, respectively; all three of these interventions were better than the control group. CONCLUSIONS: Administering Trigona honey twice daily was more effective for accelerating wound healing than the 50% or 75% turmeric extract gel. Original Trigona honey has the potential to be a post-SC wound healing agent.", "provenance": [ { "field": "n", "quote": "The test animals were 56 female white rats" }, { "field": "population", "quote": "Female white rats ( Rattus novergicus) with pre- and post-testing and a control group were included in this experiment" }, { "field": "intervention", "quote": "application of 50% and 75% turmeric extract gel and Trigona honey" }, { "field": "comparator", "quote": "all three of these interventions were better than the control group" }, { "field": "primaryOutcome", "quote": "Wounds were assessed using the Reeda Scale" }, { "field": "result", "quote": "The fastest wound healing occurred in the group given Trigona honey twice daily. Redness, ecchymosis, and edema disappeared in this group on day 9 (score 0), and granulation tissue formed on day 9." } ] }, { "id": "pmid:38425229", "pmid": "38425229", "doi": "10.1177/15347346241233236", "nctId": null, "pmcid": null, "title": "The Influence of Honey and Hydrogel Products Therapy on Healing Time in Diabetic Foot", "firstAuthor": "Searan", "multipleAuthors": true, "journal": "Int J Low Extrem Wounds", "year": 2026, "design": "rct", "n": 120, "nField": "reported", "population": "adults with type 2 diabetes and second-degree foot ulcers", "intervention": "honey alone, hydrogel alone, or honey and hydrogel used alternately", "comparator": "fucidin ointment or cream", "primaryOutcome": "time for the wound to heal", "result": "combination of honey and hydrogel alternately healed fastest (10.83 days) versus honey alone (12.20), hydrogel alone (13.97), and fucidin (14.03 days), a significant difference", "resultDirection": "benefit", "quality": "low", "qualityWhy": "small single-blinded trial in a different wound type (diabetic foot, not anorectal surgery) with only 30 patients per group.", "directness": "indirect", "limitations": "single-blinded design, small group sizes, population is diabetic foot ulcers not anorectal surgical wounds, honey type not specified as manuka", "followUp": "", "plainFinding": "Faster healing with honey-hydrogel combo.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38425229/", "sourceText": "BackgroundDiabetic foot ulcer is a serious and common complication of diabetes that often leads to significant morbidity and even amputation if not properly treated. Current treatment options, such as wound dressing, have limitations in promoting efficient healing. There is a need for effective interventions that can expedite the healing process and enhance the time required for complete healing.MethodologyThis prospective single-blinded randomized control trial studied diabetic mellitus type 2 patients with ulcer in their second-degree feet from February 2019 to February 2023 in the Diabetic Foot Center, King Fahad Specialist Hospital Al Qassim-KSA.ResultsThis study involved 120 patients with a mean age of 59.64 ± 10.21. And 63% to 52.5% of them were males and 57% to 47.5% were females. The mean healing time was about 12.76 ± 4.08 days. Cases were divided into 4 equal groups with altered treatment procedures: honey alone, hydrogel alone, honey, and hydrogel combination alternately (3 intervention groups), and fucidin ointment or cream alone (1 control group), with 30 participants in each group. We revealed that the mean healing times for honey alone, hydrogel alone, and honey and hydrogel alternately were 12.20, 13.97, and 10.83 days, respectively. While it was 14.03 days in the control Fucidin ointment or cream [significantly P < .05 (P = 0.04)].ConclusionFrom the findings of the present study, we noticed that faster healing time among diabetic foot cases could be accomplished by treatment with a combination of honey and hydrogel alternately. Therefore, this therapy is effective in reducing the risk of diabetic foot ulcers.", "provenance": [ { "field": "n", "quote": "This study involved 120 patients" }, { "field": "population", "quote": "diabetic mellitus type 2 patients with ulcer in their second-degree feet" }, { "field": "intervention", "quote": "Cases were divided into 4 equal groups with altered treatment procedures: honey alone, hydrogel alone, honey, and hydrogel combination alternately (3 intervention groups)" }, { "field": "comparator", "quote": "fucidin ointment or cream alone (1 control group)" }, { "field": "primaryOutcome", "quote": "The mean healing time was about 12.76 ± 4.08 days." }, { "field": "result", "quote": "the mean healing times for honey alone, hydrogel alone, and honey and hydrogel alternately were 12.20, 13.97, and 10.83 days, respectively. While it was 14.03 days in the control Fucidin ointment or cream [significantly P < .05 (P = 0.04)]." } ] }, { "id": "pmid:38358154", "pmid": "38358154", "doi": "10.4103/aam.aam_10_22", "nctId": null, "pmcid": "PMC10775929", "title": "Wound bed preparation using nonsurgical methods: A prospective comparative study of honey versus unripe papaya (Carica papaya)", "firstAuthor": "Nnadozie", "multipleAuthors": true, "journal": "Ann Afr Med", "year": 2023, "design": "prospective-cohort", "n": 64, "nField": "reported", "population": "patients with wounds needing eschar/slough removal before healing", "intervention": "honey dressing", "comparator": "unripe papaya dressing", "primaryOutcome": "time for dead tissue (eschar) to separate and for infection to clear", "result": "honey took much longer than papaya to clear eschar and infection", "resultDirection": "harm", "quality": "low", "qualityWhy": "small study that wasn't clearly randomized and compared two active treatments rather than honey versus no treatment", "directness": "indirect", "limitations": "not stated as randomized, no blinding described, compares honey to papaya rather than placebo or standard care, not anorectal surgery population", "followUp": "", "plainFinding": "Papaya cleared wounds faster than honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38358154/", "sourceText": "BACKGROUND: The rapidity of wound bed preparation is determined in part by the type of dressing agent employed. The extension phase in which the wound is characterized by the presence of sloughs and eschar and microbial invasion could be managed nonsurgically. OBJECTIVE: The objective of this study was to compare the rapidity of wound bed preparation using unripe papaya versus honey. MATERIALS AND METHODS: Sixty-four patients were assigned into two equal groups, each dressed, respectively, with unripe papaya or honey. All selected patients were monitored for eschar separation and bacterial clearance time. Data obtained with a pro forma were analyzed with SPSS version 25. RESULTS: Unripe papaya dressing had a mean eschar separation time of 5.53 ± 2.20 days and bacterial clearance time of 6.81 ± 3.64 days compared to the honey group which had an eschar separation time of 30.09 ± 27.90 days and bacterial clearance time of 15.33 ± 13.62 days. P <0.001 and P < 0.001, respectively, in comparing both outcome measures between the two groups. There was a statistically significant difference in both eschar/slough separation time and bacterial clearance time both in favor of the group prepared with unripe papaya. CONCLUSION: The use of unripe papaya was superior to honey in wound bed preparation with respect to eschar/slough separation, bacterial clearance ultimately resulting in reduced length of hospital stay.", "provenance": [ { "field": "n", "quote": "Sixty-four patients were assigned into two equal groups" }, { "field": "population", "quote": "The extension phase in which the wound is characterized by the presence of sloughs and eschar and microbial invasion could be managed nonsurgically." }, { "field": "intervention", "quote": "each dressed, respectively, with unripe papaya or honey" }, { "field": "comparator", "quote": "each dressed, respectively, with unripe papaya or honey" }, { "field": "primaryOutcome", "quote": "All selected patients were monitored for eschar separation and bacterial clearance time." }, { "field": "result", "quote": "Unripe papaya dressing had a mean eschar separation time of 5.53 ± 2.20 days and bacterial clearance time of 6.81 ± 3.64 days compared to the honey group which had an eschar separation time of 30.09 ± 27.90 days and bacterial clearance time of 15.33 ± 13.62 days." } ] }, { "id": "pmid:38197284", "pmid": "38197284", "doi": "10.12968/jowc.2024.33.1.75", "nctId": null, "pmcid": null, "title": "Honey dressing for penile skin avulsion caused by traditional circumcision: a case report", "firstAuthor": "Suryadinata", "multipleAuthors": true, "journal": "J Wound Care", "year": 2024, "design": "case-series", "n": null, "nField": "not-reported", "population": "24-year-old man with penile skin loss from traditional circumcision", "intervention": "honey dressing on the wound", "comparator": "none described", "primaryOutcome": "complete wound healing (re-epithelialisation)", "result": "wound fully re-healed by day 43 without becoming a chronic wound", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report with no comparison group, so it cannot show whether honey caused the healing or whether another treatment would have done the same or better.", "directness": "indirect", "limitations": "Single case, no control group, wound type and setting (traditional circumcision injury) differ from anorectal surgery, honey brand not specified as manuka.", "followUp": "43 days", "plainFinding": "Wound fully healed in one patient.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38197284/", "sourceText": "OBJECTIVE: Penile skin avulsion is a rare complication of circumcision but commonly encountered as the result of traditional practice. We aimed to present the use of honey dressing and the benefit of its wound healing properties for management of such a complex wound. CASE: A 24-year-old male patient with penile bleeding presented to the emergency department after undergoing traditional circumcision. Complete degloving of the penis with active bleeding and foul odour, along with heavy contamination of chewed betel leaves and powdered amoxicillin was found. Honey (Madu Nusantara, PT. Madu Nusantara, Indonesia) was used as dressing after copious irrigation using saline and povidone-iodine with bleeding control. RESULTS: Honey dressing was shown to be effective for secondary wound healing of such a complicated and contaminated wound-in this case due to its antimicrobial, anti-inflammatory, immunostimulatory and autolytic debridement properties. A complete re-epithelialisation of the wound was achieved without progression to the hard-to-heal state by day 43. Suboptimal sexual function and aesthetic result due to wound contracture were observed as surgical reconstruction via split-thickness skin graft was refused due to cost. CONCLUSION: In this case report, honey dressing was shown to be effective for wound healing, even in a penile avulsion with complete skin loss and heavy contamination. In rural settings, where penile avulsion due to traditional circumcision is common, honey should be considered as one of the dressing choices.", "provenance": [ { "field": "population", "quote": "A 24-year-old male patient with penile bleeding presented to the emergency department after undergoing traditional circumcision." }, { "field": "intervention", "quote": "Honey (Madu Nusantara, PT. Madu Nusantara, Indonesia) was used as dressing after copious irrigation using saline and povidone-iodine with bleeding control." }, { "field": "comparator", "quote": "RESULTS: Honey dressing was shown to be effective for secondary wound healing of such a complicated and contaminated wound" }, { "field": "primaryOutcome", "quote": "A complete re-epithelialisation of the wound was achieved without progression to the hard-to-heal state by day 43." }, { "field": "result", "quote": "A complete re-epithelialisation of the wound was achieved without progression to the hard-to-heal state by day 43." } ] }, { "id": "pmid:37990423", "pmid": "37990423", "doi": "10.1021/acsami.3c11093", "nctId": null, "pmcid": null, "title": "Keratin- and VEGF-Incorporated Honey-Based Sponge-Nanofiber Dressing: An Ideal Construct for Wound Healing", "firstAuthor": "Tavakoli", "multipleAuthors": true, "journal": "ACS Appl Mater Interfaces", "year": 2023, "design": "animal", "n": null, "nField": "not-reported", "population": "full-thickness wounds in an animal model", "intervention": "bilayer honey-based dressing with keratin and VEGF (PAAc-Hny/Hny-Kr-VEGF)", "comparator": "other wound dressing groups", "primaryOutcome": "speed and quality of wound healing (blood vessel formation, collagen synthesis, epidermal regeneration)", "result": "the wound healed faster when covered with the honey-based bilayer dressing compared to other groups", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a small preclinical animal/lab study, not a human clinical trial, so it offers limited evidence for people.", "directness": "indirect", "limitations": "no participant numbers reported, animal model only, no human data, no mention of anorectal surgery context", "followUp": "", "plainFinding": "Faster wound healing in animals.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37990423/", "sourceText": "To overcome the drawbacks of single-layered wound dressings, bilayer dressings are now introduced as an alternative to achieve effective and long-term treatment. Here, a bilayer dressing composed of electrospun nanofibers in the bottom layer (BL) and a sponge structure as the top layer (TL) is presented. Hydrophilic poly(acrylic acid) (PAAc)-honey (Hny) with interconnected pores of 76.04 μm was prepared as the TL and keratin (Kr), Hny, and vascular endothelial growth factor (VEGF) were prepared as the BL. VEGF indicates a gradual release over 7 days, promoting angiogenesis, as proven by the chick chorioallantoic membrane assay and in vivo tissue histomorphology observation. Additionally, the fabricated dressing material indicated a satisfactory tensile profile, cytocompatibility for human keratinocyte cells, and the ability to promote cell attachment and migration. The in vivo animal model demonstrated that the full-thickness wound healed faster when it was covered with PAAc-Hny/Hny-Kr-VEGF than in other groups. Additionally, faster blood vessel formation, collagen synthetization, and epidermal layer generation were also confirmed, which have proven efficient healing acceleration in wounds treated with synthesized bilayer dressings. Our findings indicated that the fabricated material can be promising as a functional wound dressing.", "provenance": [ { "field": "population", "quote": "full-thickness wound healed faster when it was covered with PAAc-Hny/Hny-Kr-VEGF than in other groups" }, { "field": "intervention", "quote": "PAAc-Hny/Hny-Kr-VEGF" }, { "field": "comparator", "quote": "than in other groups" }, { "field": "primaryOutcome", "quote": "faster blood vessel formation, collagen synthetization, and epidermal layer generation were also confirmed" }, { "field": "result", "quote": "The in vivo animal model demonstrated that the full-thickness wound healed faster when it was covered with PAAc-Hny/Hny-Kr-VEGF than in other groups." } ] }, { "id": "pmid:37964535", "pmid": "37964535", "doi": "10.1177/15347346231214597", "nctId": null, "pmcid": null, "title": "The Effect of Honey, Aloe Vera, and Hydrocolloid Dressing on the Healing Process of Murine Excisional Wounds", "firstAuthor": "Hernández-Rodríguez", "multipleAuthors": true, "journal": "Int J Low Extrem Wounds", "year": 2026, "design": "animal", "n": null, "nField": "not-reported", "population": "mice with full-thickness skin wounds", "intervention": "honey dressing", "comparator": "aloe vera and hydrocolloid dressing", "primaryOutcome": "wound diameter / healing", "result": "aloe vera reduced wound diameter compared with honey and the control hydrocolloid group", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small animal (mouse) experiment, not a human study, and it does not directly compare honey against a control in a way that lets us judge honey's own effect.", "directness": "indirect", "limitations": "Animal (mouse) model, not human anorectal surgery; abstract does not report numbers of animals or directly state honey vs control comparison", "followUp": "", "plainFinding": "Aloe vera healed wounds better than honey in mice.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37964535/", "sourceText": "Chronic ulcers are a major health problem associated with high costs and a loss of quality of life. Because of this, the search for products that accelerate wound healing is a constant, given the need for alternatives that help to alleviate this serious health problem. We analyzed the efficacy of 2 natural products-honey and aloe vera-versus hydrocolloid (HC) dressings as a control group in healing full-thickness wounds. For this purpose, we performed full-thickness excisions of the skin, including the panniculus carnosus, in mice. We inserted a nitrile ring into the subcutaneous cellular tissue simulating the second-intention wound healing course. We found that aloe vera reduced the diameter of the wounds compared to honey (p < .001) and the control group (p < .001).", "provenance": [ { "field": "population", "quote": "we performed full-thickness excisions of the skin, including the panniculus carnosus, in mice" }, { "field": "intervention", "quote": "We analyzed the efficacy of 2 natural products-honey and aloe vera-versus hydrocolloid (HC) dressings as a control group in healing full-thickness wounds" }, { "field": "comparator", "quote": "versus hydrocolloid (HC) dressings as a control group" }, { "field": "primaryOutcome", "quote": "We analyzed the efficacy of 2 natural products-honey and aloe vera-versus hydrocolloid (HC) dressings as a control group in healing full-thickness wounds" }, { "field": "result", "quote": "We found that aloe vera reduced the diameter of the wounds compared to honey (p < .001) and the control group (p < .001)." } ] }, { "id": "pmid:37940425", "pmid": "37940425", "doi": "10.1016/j.burns.2023.10.009", "nctId": null, "pmcid": null, "title": "Comparing the antibacterial and healing properties of medical-grade honey and silver-based wound care products in burns", "firstAuthor": "Boekema", "multipleAuthors": true, "journal": "Burns", "year": 2024, "design": "lab", "n": null, "nField": "not-reported", "population": "human burn wound tissue infected with bacteria (ex vivo model), plus some clinical burn cases", "intervention": "medical-grade honey (Medihoney/Manuka and L-Mesitran Soft)", "comparator": "silver-based wound products (Flammazine, silver nitrate)", "primaryOutcome": "bacterial reduction and wound healing (re-epithelialization and keratinocyte proliferation)", "result": "Medihoney (Manuka) killed bacteria but caused complete lack of re-epithelialization and keratinocyte proliferation, performing worse than silver-based products and the honey blend L-Mesitran", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "This was a lab-based ex vivo tissue model with no reported patient numbers or controlled clinical trial design, so it can't reliably predict real-world healing outcomes.", "directness": "indirect", "limitations": "Ex vivo burn wound model, not a clinical trial; no participant numbers reported; clinical cases mentioned only as illustrative examples, not systematically studied.", "followUp": "", "plainFinding": "Manuka honey stopped wound skin regrowth.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37940425/", "sourceText": "Burns are a major global healthcare concern, often complicated by the presence of bacteria such as Pseudomonas aeruginosa in the wounds. Silver-based dressings are commonly used in the treatment of burns but can cause skin irritation and delay healing time. Medical-grade honey (MGH) provides an interesting alternative. This study investigated the antimicrobial effects and possible cytotoxicity of L-Mesitran Soft (MGH-gel) and its individual components, Medihoney (Manuka), Flammazine (silver sulphadiazine), and silver nitrate (AgNO3) in an ex vivo human burn wound model. Bacterial survival and wound healing parameters, including re-epithelialization and keratinocyte proliferation were assessed. L-Mesitran, Flammazine, and AgNO3 reduced P. aeruginosa numbers below detection levels. L-Mesitran Soft exhibited a significantly stronger antimicrobial effect compared to Medihoney. The individual components of L-Mesitran contributed significantly to its antibacterial efficacy, thus suggesting synergistic activities. Moreover, L-Mesitran, Flammazine, and AgNO3 slightly inhibited re-epithelialization while Medihoney treatment resulted in a complete lack of re-epithelialization and keratinocyte proliferation. Furthermore, clinical cases illustrated the effectiveness of MGH therapy in infected burns. Overall, L-Mesitran Soft had similar effects as silver-based products on bacterial load and epidermal regeneration, but outperformed Medihoney. Therefore, supplemented MGH could be used as an effective alternative to silver-based dressings for P. aeruginosa-infected burns.", "provenance": [ { "field": "population", "quote": "ex vivo human burn wound model" }, { "field": "intervention", "quote": "Medihoney (Manuka)" }, { "field": "comparator", "quote": "Flammazine (silver sulphadiazine), and silver nitrate (AgNO3)" }, { "field": "primaryOutcome", "quote": "Bacterial survival and wound healing parameters, including re-epithelialization and keratinocyte proliferation were assessed." }, { "field": "result", "quote": "Medihoney treatment resulted in a complete lack of re-epithelialization and keratinocyte proliferation" }, { "field": "result", "quote": "L-Mesitran Soft exhibited a significantly stronger antimicrobial effect compared to Medihoney." } ] }, { "id": "pmid:37791895", "pmid": "37791895", "doi": "10.1093/lambio/ovad119", "nctId": null, "pmcid": null, "title": "Antibiofilm activity of promethazine, deferiprone, and Manuka honey in an ex vivo wound model", "firstAuthor": "Guedes", "multipleAuthors": true, "journal": "Lett Appl Microbiol", "year": 2023, "design": "lab", "n": null, "nField": "not-reported", "population": "porcine skin wound model infected with bacteria (not human patients)", "intervention": "Manuka honey (along with promethazine and deferiprone) applied to bacterial biofilms", "comparator": "untreated bacterial biofilms", "primaryOutcome": "reduction of bacterial biofilm (colony counts and biomass) on skin", "result": "Manuka honey reduced biofilm biomass of Staph aureus and reduced bacterial counts in the ex vivo skin model, but effects varied by bacteria species", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "This is a lab experiment on pig skin and bacteria, not a clinical trial in people with wounds, so it cannot show whether honey helps real patients heal.", "directness": "indirect", "limitations": "In vitro and ex vivo only, no living human or animal wound healing tested, authors state further studies needed to confirm effectiveness in vivo.", "followUp": "", "plainFinding": "Reduced bacteria in lab skin model.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37791895/", "sourceText": "This study evaluated the antibiofilm activity of promethazine, deferiprone, and Manuka honey against Staphylococcus aureus and Pseudomonas aeruginosa in vitro and ex vivo in a wound model on porcine skin. The minimum inhibitory concentrations (MICs) and the effects of the compounds on biofilms were evaluated. Then, counting colony-forming units (CFUs) and confocal microscopy were performed on biofilms cultivated on porcine skin for evaluation of the compounds. For promethazine, MICs ranging from 97.66 to 781.25 µg/ml and minimum biofilm eradication concentration (MBEC) values ranging from 195.31 to 1562.5 µg/ml were found. In addition to reducing the biomass of both species' biofilms. As for deferiprone, the MICs were 512 and >1024 µg/ml, the MBECs were ≥1024 µg/ml, and it reduced the biomass of biofilms. Manuka honey had MICs of 10%-40%, MBECs of 20 to >40% and reduced the biomass of S. aureus biofilms only. Concerning the analyses in the ex vivo model, the compounds reduced (P < .05) CFU counts for both bacterial species, altering the biofilm architecture. The action of the compounds on biofilms in in vitro and ex vivo tests raises the possibility of using them against biofilm-associated wounds. However, further studies are needed to characterize the mechanisms of action and their effectiveness on biofilms in vivo.", "provenance": [ { "field": "population", "quote": "biofilms cultivated on porcine skin for evaluation of the compounds" }, { "field": "intervention", "quote": "Manuka honey against Staphylococcus aureus and Pseudomonas aeruginosa in vitro and ex vivo in a wound model on porcine skin" }, { "field": "comparator", "quote": "counting colony-forming units (CFUs) and confocal microscopy were performed on biofilms cultivated on porcine skin for evaluation of the compounds" }, { "field": "primaryOutcome", "quote": "The minimum inhibitory concentrations (MICs) and the effects of the compounds on biofilms were evaluated" }, { "field": "result", "quote": "Manuka honey had MICs of 10%-40%, MBECs of 20 to >40% and reduced the biomass of S. aureus biofilms only" }, { "field": "result", "quote": "the compounds reduced (P < .05) CFU counts for both bacterial species, altering the biofilm architecture" }, { "field": "limitations", "quote": "However, further studies are needed to characterize the mechanisms of action and their effectiveness on biofilms in vivo." } ] }, { "id": "pmid:37784205", "pmid": "37784205", "doi": "10.1186/s13047-023-00653-9", "nctId": null, "pmcid": "PMC10544608", "title": "The impact of wound pH on the antibacterial properties of Medical Grade Honey when applied to bacterial isolates present in common foot and ankle wounds. An in vitro study", "firstAuthor": "McArdle", "multipleAuthors": true, "journal": "J Foot Ankle Res", "year": 2023, "design": "lab", "n": null, "nField": "not-reported", "population": "bacteria commonly found in diabetic foot ulcers and post-surgical foot and ankle wounds", "intervention": "medical grade honey adjusted to different pH levels (6, 7, 8)", "comparator": "control solution (TSB) at same pH levels", "primaryOutcome": "ability of honey to kill or reduce bacteria at different pH levels", "result": "honey reduced bacteria at all pH levels tested, with no clear link between pH and bacteria killed", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this was a lab dish experiment on bacteria, not a study in real patients or wounds, so it cannot show whether honey actually helps wounds heal.", "directness": "indirect", "limitations": "in vitro study only; no human participants, no wound healing outcomes measured", "followUp": "", "plainFinding": "Honey killed bacteria in lab dish.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37784205/", "sourceText": "BACKGROUND: Diabetic foot ulcers (DFUs) and post-surgical wound infections are amongst the most troublesome complications of diabetes and following foot and ankle surgery (FAS) respectively. Both have significant psychosocial and financial burden for both patients and the healthcare system. FAS has been reported to have higher than average post-surgical infections when compared to other orthopaedic subspecialties. Evidence also indicates that patients with diabetes and other co morbidities undergoing FAS are at a much greater risk of developing surgical site infections (SSIs). With the growing challenges of antibiotic resistance and the increasingly high numbers of resilient bacteria to said antibiotics, the need for alternative antimicrobial therapies has become critical. AIM: The aim of this study was to investigate the use of medical grade honey (MGH) when altered to environments typically present in foot and ankle wounds including DFUs and post-surgical wounds (pH6-8). METHODS: MGH (Activon) was altered to pH 6, 7 and 8 and experimental inoculums of Pseudomonas aeruginosa (NCTC10782), Escherichia coli, (NCTC10418), Staphylococcus aureus (NCTC10655) and Staphylococcus epidermidis (NCTC 5955) were transferred into each pH adjusted MGH and TSB solution and the positive and negative controls. RESULTS: MGH adjusted to various pH values had the ability to reduce bacteria cell survival in all pH variations for all bacteria tested, with the most bacterial reduction/elimination noted for Staphylococcus epidermidis. No correlations were noted among the pH environments investigated and the colony counts, for which there were small amounts of bacteria survived. CONCLUSION: This research would indicate that the antibacterial properties of honey remains the same regardless of the pH environment. MGH could therefore potentially be considered for use on non-infected foot and ankle wounds to reduce the bacterial bioburden, the risk of infections and ultimately to improve healing outcomes.", "provenance": [ { "field": "population", "quote": "Pseudomonas aeruginosa (NCTC10782), Escherichia coli, (NCTC10418), Staphylococcus aureus (NCTC10655) and Staphylococcus epidermidis (NCTC 5955)" }, { "field": "intervention", "quote": "MGH (Activon) was altered to pH 6, 7 and 8" }, { "field": "comparator", "quote": "transferred into each pH adjusted MGH and TSB solution and the positive and negative controls" }, { "field": "primaryOutcome", "quote": "investigate the use of medical grade honey (MGH) when altered to environments typically present in foot and ankle wounds" }, { "field": "result", "quote": "MGH adjusted to various pH values had the ability to reduce bacteria cell survival in all pH variations for all bacteria tested" }, { "field": "result", "quote": "No correlations were noted among the pH environments investigated and the colony counts" } ] }, { "id": "pmid:37367130", "pmid": "37367130", "doi": "10.3390/gels9060459", "nctId": null, "pmcid": "PMC10298319", "title": "Development of Natural Active Agent-Containing Porous Hydrogel Sheets with High Water Content for Wound Dressings", "firstAuthor": "Pinthong", "multipleAuthors": true, "journal": "Gels", "year": 2023, "design": "lab", "n": null, "nField": "not-reported", "population": "not applicable (laboratory material testing, no patients)", "intervention": "porous hydrogel wound dressing containing manuka honey", "comparator": "non-porous hydrogel without manuka honey (and different honey concentrations)", "primaryOutcome": "physical properties of the hydrogel such as swelling, absorption, structure, and cell toxicity", "result": "the honey-containing porous hydrogel absorbed and swelled with fluid better and had improved structure, but this was tested on materials, not on wounds or patients", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this was a laboratory test of hydrogel material properties, not a study of wound healing in people, so it cannot show whether manuka honey helps wounds heal.", "directness": "indirect", "limitations": "no patients, no wounds, no clinical outcome measured; only material and cell-cytotoxicity testing in the lab", "followUp": "", "plainFinding": "Lab material test only, no patients.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37367130/", "sourceText": "This work was concerned with the fabrication of a porous hydrogel system suitable for medium to heavy-exudating wounds where traditional hydrogels cannot be used. The hydrogels were based on 2-acrylamido-2-methyl-1-propane sulfonic acid (AMPs). In order to produce the porous structure, additional components were added (acid, blowing agent, foam stabilizer). Manuka honey (MH) was also incorporated at concentrations of 1 and 10% w/w. The hydrogel samples were characterized for morphology via scanning electron microscopy, mechanical rheology, swelling using a gravimetric method, surface absorption, and cell cytotoxicity. The results confirmed the formation of porous hydrogels (PH) with pore sizes ranging from ~50-110 µm. The swelling performance showed that the non-porous hydrogel (NPH) swelled to ~2000%, while PH weight increased ~5000%. Additionally, the use of a surface absorption technique showed that the PH absorbed 10 μL in <3000 ms, and NPH absorbed <1 μL over the same time. Incorporating MH the enhanced gel appearance and mechanical properties, including smaller pores and linear swelling. In summary, the PH produced in this study had excellent swelling performance with rapid absorption of surface liquid. Therefore, these materials have the potential to expand the applicability of hydrogels to a range of wound types, as they can both donate and absorb fluid.", "provenance": [ { "field": "population", "quote": "porous hydrogel system suitable for medium to heavy-exudating wounds" }, { "field": "intervention", "quote": "Manuka honey (MH) was also incorporated at concentrations of 1 and 10% w/w" }, { "field": "comparator", "quote": "the non-porous hydrogel (NPH) swelled to ~2000%, while PH weight increased ~5000%" }, { "field": "primaryOutcome", "quote": "characterized for morphology via scanning electron microscopy, mechanical rheology, swelling using a gravimetric method, surface absorption, and cell cytotoxicity" }, { "field": "result", "quote": "Incorporating MH the enhanced gel appearance and mechanical properties, including smaller pores and linear swelling" } ] }, { "id": "pmid:37164834", "pmid": "37164834", "doi": "10.1016/j.jcms.2023.05.001", "nctId": null, "pmcid": null, "title": "Effect of manuka honey socket dressing on postoperative sequelae and complications following third molar extraction: A randomized controlled study", "firstAuthor": "Onuoha", "multipleAuthors": true, "journal": "J Craniomaxillofac Surg", "year": 2023, "design": "rct", "n": 112, "nField": "reported", "population": "patients having mandibular third molar (wisdom tooth) extraction", "intervention": "manuka honey placed in the extraction socket before closing the gum", "comparator": "socket closed without manuka honey", "primaryOutcome": "healing of the extraction socket at 7 days", "result": "fewer unhealed sockets and fewer complications with manuka honey at 7 days", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but single-center, not blinded, and measured only short-term healing at 7 days", "directness": "indirect", "limitations": "abstract does not mention blinding; study is in tooth extraction sockets, not anorectal surgery wounds", "followUp": "7 days", "plainFinding": "Faster socket healing, fewer complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37164834/", "sourceText": "To evaluate the effect of manuka honey on the healing of mandibular third molar extraction sockets. This was a prospective randomized study at a tertiary health institution in Lagos, Nigeria. All extractions were transalveolar, using the distobuccal bone guttering technique. Participants were randomized into two study groups. Group A underwent intrasocket application of manuka honey, after which sockets were completely closed using the mucosal flap, while participants in group B underwent mucosal flap closure of the socket without application of manuka honey. The primary outcome was healing of the extraction socket at 7 days postoperatively. The secondary outcomes measured were postoperative sequelae, namely pain, swelling, and trismus on postoperative days 1, 3, and 7, and socket healing complications - specifically inflamed socket, infected socket, and alveolar osteitis. In total, 112 participants completed the study, with 56 participants per group. There were no significant differences in demographic variables between both groups. On the 7th day postoperatively, 26.8% of participants in group B had an unhealed extraction site, compared with 10.3% of participants in group A (p = 0.029). A significant difference was observed between pre- and postoperative pain scores in both study groups (p = 0.001). A comparison of postoperative mean facial swelling between the two groups showed no statistically significant differences on all the review days (p = 0.66). The difference in postoperative socket healing complication rate between both groups was statistically significant (χ2 = 4.747, p = 0.029). Within the limitations of the study it seems that the application of manuka honey appears to aid earlier healing of the third molar extraction socket, with a significantly lower frequency of complications. Therefore, the application of manuka honey is recommended whenever appropriate.", "provenance": [ { "field": "n", "quote": "In total, 112 participants completed the study, with 56 participants per group." }, { "field": "population", "quote": "mandibular third molar extraction sockets" }, { "field": "intervention", "quote": "Group A underwent intrasocket application of manuka honey, after which sockets were completely closed using the mucosal flap" }, { "field": "comparator", "quote": "participants in group B underwent mucosal flap closure of the socket without application of manuka honey" }, { "field": "primaryOutcome", "quote": "The primary outcome was healing of the extraction socket at 7 days postoperatively." }, { "field": "result", "quote": "On the 7th day postoperatively, 26.8% of participants in group B had an unhealed extraction site, compared with 10.3% of participants in group A (p = 0.029)." } ] }, { "id": "pmid:37032304", "pmid": "37032304", "doi": "10.1016/j.jtv.2023.03.002", "nctId": null, "pmcid": null, "title": "Use of honey in diabetic foot ulcer: Systematic review and meta-analysis", "firstAuthor": "Yildiz Karadeniz", "multipleAuthors": true, "journal": "J Tissue Viability", "year": 2023, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people with diabetic foot ulcers", "intervention": "honey dressing on the wound", "comparator": "standard wound care (implied, not stated explicitly)", "primaryOutcome": "wound healing time, pain, hospital stay, and granulation", "result": "Honey reduced healing time, pain, and hospital stay, and increased granulation", "resultDirection": "benefit", "quality": "low", "qualityWhy": "The abstract gives no numbers of patients or studies, mixes different study designs, and gives no detail on bias or honey type, so it's hard to trust the strength of the result.", "directness": "indirect", "limitations": "Abstract does not report sample size, specific honey type, or risk of bias; mixes RCTs, quasi-experimental and cross-sectional designs.", "followUp": "", "plainFinding": "Honey sped up wound healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/37032304/", "sourceText": "OBJECTIVE: The aim of this study was to evaluate the role of honey dressing as an effective intervention for diabetic foot wound management and to provide a reliable basis for future clinical study. MATERIALS AND METHODS: We analyzed an assortment of randomized controlled trial (RCT), quasi-experimental and cross-sectional studies. We selected RCTs and quasi-experimental studies for meta-analysis. We only conducted a descriptive analysis for observational studies. RESULTS: The meta-analysis showed that honey used effectively reduces wound recovery time and rate, incurred pain, hospital stay, and accelerates granulation in DFU wounds. CONCLUSIONS: Our findings suggest that honey effectively promotes healing in DFU. Further research is needed to elucidate these findings so that this form of treatment can be widely applied.", "provenance": [ { "field": "population", "quote": "effective intervention for diabetic foot wound management" }, { "field": "intervention", "quote": "honey dressing" }, { "field": "primaryOutcome", "quote": "wound recovery time and rate, incurred pain, hospital stay, and accelerates granulation in DFU wounds" }, { "field": "result", "quote": "honey used effectively reduces wound recovery time and rate, incurred pain, hospital stay, and accelerates granulation in DFU wounds" }, { "field": "comparator", "quote": "We analyzed an assortment of randomized controlled trial (RCT), quasi-experimental and cross-sectional studies." } ] }, { "id": "pmid:36994798", "pmid": "36994798", "doi": "10.1111/iwj.14135", "nctId": null, "pmcid": "PMC10410322", "title": "Effect of honey dressing in the management of diabetic foot ulcers: A meta-analysis", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Int Wound J", "year": 2023, "design": "meta-analysis", "n": 882, "nField": "reported", "population": "people with diabetic foot ulcers", "intervention": "honey dressing applied to the wound", "comparator": "standard wound care (control)", "primaryOutcome": "wound healing rate and time to healing", "result": "honey dressing led to higher healing rates and faster healing than control", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a retracted publication pooling mostly small, low-quality studies, so its findings cannot be trusted.", "directness": "indirect", "limitations": "Abstract states most included studies had low sample sizes and urges caution interpreting results; publication is listed as retracted.", "followUp": "", "plainFinding": "Faster healing in diabetic foot ulcers", "retracted": true, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36994798/", "sourceText": "A meta-analysis study to assess the effect of honey dressing (HD) in the management of diabetic foot ulcer (DFU). A comprehensive literature examination till January 2023 was implemented and 1794 linked studies were appraised. The picked studies contained 882 subjects with DFUs were in the picked studies' baseline, 424 of them were using HD, and 458 were using a control. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to calculate the consequence of HD in the management of DFUs after DFU by the dichotomous and continuous styles and a fixed or random model. The HD applied to DFUs caused a significantly higher wound healing rate (OR, 2.06; 95% CI, 1.45-2.93, P < .001) and lower wound healing time (MD, -10.42; 95% CI, -16.27- -4.58, P < .001) compared with the control. The HD applied to DFUs caused a significantly higher wound healing rate and lower wound healing time compared with the control. Although precautions should be taken when commerce with the consequences since most of the picked studies for this meta-analysis was with low sample sizes.", "provenance": [ { "field": "n", "quote": "The picked studies contained 882 subjects with DFUs were in the picked studies' baseline, 424 of them were using HD, and 458 were using a control." }, { "field": "population", "quote": "diabetic foot ulcer (DFU)" }, { "field": "intervention", "quote": "honey dressing (HD)" }, { "field": "comparator", "quote": "458 were using a control" }, { "field": "primaryOutcome", "quote": "The HD applied to DFUs caused a significantly higher wound healing rate (OR, 2.06; 95% CI, 1.45-2.93, P < .001) and lower wound healing time (MD, -10.42; 95% CI, -16.27- -4.58, P < .001) compared with the control." }, { "field": "result", "quote": "The HD applied to DFUs caused a significantly higher wound healing rate (OR, 2.06; 95% CI, 1.45-2.93, P < .001) and lower wound healing time (MD, -10.42; 95% CI, -16.27- -4.58, P < .001) compared with the control." }, { "field": "limitations", "quote": "precautions should be taken when commerce with the consequences since most of the picked studies for this meta-analysis was with low sample sizes." } ] }, { "id": "pmid:36959360", "pmid": "36959360", "doi": "10.1007/s00381-023-05929-w", "nctId": null, "pmcid": null, "title": "Fighting postsurgical infection after myelomeningocele repair with medical honey (Medihoney): a case report", "firstAuthor": "Hajmohammadi", "multipleAuthors": true, "journal": "Childs Nerv Syst", "year": 2023, "design": "case-series", "n": 1, "nField": "reported", "population": "newborn baby girl with infected surgical wound after spina bifida repair", "intervention": "medical honey dressing (Medihoney)", "comparator": "previous standard wound care (wet gauze and Vaseline dressing, antibiotics)", "primaryOutcome": "healing of the infected surgical wound", "result": "the infection healed completely after 2 months of honey treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report with no comparison group, so it cannot show whether honey caused the improvement.", "directness": "indirect", "limitations": "only one patient, no control group, and the wound is a neurosurgical infection site, not an anorectal surgery wound.", "followUp": "2 months", "plainFinding": "Infected wound healed with honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36959360/", "sourceText": "Surgical site infection (SSI) prolongs the treatment period, delays wound healing, increases antibiotic consumption, and leads to patient death in complicated cases. This case was a 10-day female infant born at 37-week- and 6-day of gestational age with a birth weight of 3700 g and Apgar 5/8 by emergency cesarean section due to spina bifida cystica with myelomeningocele (MMC). She was admitted to the neonatal intensive care unit (NICU) because of respiratory distress and hypotonic lower extremities on June 2, 2022. A cardiovascular and neurosurgery consult was okay for reconstructive surgery, and she had MMC repair surgery by a plastic surgeon on June 5, 2022. The surgical site was infected, and SSI had no improvement, despite regularly receiving wet and Vaseline gauze dressing and intravenous antibiotic therapy. We started the treatment using Medihoney™, honey antibacterial wound dressing, on SSI once a day for 2 weeks, then once every other day for the next 6 weeks. Her SSI was cured entirely after 2 months, and she was discharged from our wound treatment team in satisfactory general condition. Clinicians and wound care management teams could use honey antibacterial wound gel to treat SSI, particularly in newborns with weakened immune systems after spinal birth defects repair.", "provenance": [ { "field": "population", "quote": "a 10-day female infant born at 37-week- and 6-day of gestational age with a birth weight of 3700 g and Apgar 5/8 by emergency cesarean section due to spina bifida cystica with myelomeningocele (MMC)" }, { "field": "intervention", "quote": "We started the treatment using Medihoney™, honey antibacterial wound dressing, on SSI once a day for 2 weeks, then once every other day for the next 6 weeks." }, { "field": "comparator", "quote": "despite regularly receiving wet and Vaseline gauze dressing and intravenous antibiotic therapy" }, { "field": "primaryOutcome", "quote": "Her SSI was cured entirely after 2 months" }, { "field": "result", "quote": "Her SSI was cured entirely after 2 months, and she was discharged from our wound treatment team in satisfactory general condition." }, { "field": "n", "quote": "This case was a 10-day female infant" } ] }, { "id": "pmid:36812084", "pmid": "36812084", "doi": "10.1097/01.ASW.0000911996.22146.51", "nctId": null, "pmcid": null, "title": "Topical Intervention of Natural Products Applied in Patients with Pressure Injuries: A Scoping Review", "firstAuthor": "Ouchi", "multipleAuthors": true, "journal": "Adv Skin Wound Care", "year": 2023, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "patients with pressure injuries (bedsores)", "intervention": "topical natural products such as honey and Plantago major dressings", "comparator": "standard control wound treatment", "primaryOutcome": "wound healing or wound size reduction", "result": "Honey and Plantago major dressings significantly reduced wound size compared with control treatments", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a scoping review of only six small controlled trials on pressure injuries, not surgical wounds, so it can't strongly support use for anorectal surgery.", "directness": "indirect", "limitations": "Only six controlled trials were found, and the review notes limited controlled clinical trials addressing natural products and pressure injuries in the literature.", "followUp": "", "plainFinding": "Honey dressings reduced wound size.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36812084/", "sourceText": "OBJECTIVE: Pressure injuries (PIs) represent a major medical and nursing problem in individuals with decreased or limited mobility. This scoping review aimed to map the controlled clinical trials with topical interventions of natural products applied to patients with PIs and to verify the existence of phytochemical similarities among these products. DATA SOURCES: This scoping review was developed according to the JBI Manual for Evidence Synthesis. Controlled trials were searched in the following electronic databases from their inceptions until February 1, 2022: Cochrane Central Register of Controlled Trials, EMBASE, PubMed, SciELO, Science Direct, and Google Scholar. STUDY SELECTION: Studies involving individuals with PIs, individuals treated with topical natural products compared to a control treatment, and outcomes with wound healing or wound reduction were included in this review. DATA EXTRACTION: The search identified 1,268 records. Only six studies were included in this scoping review. Data were independently extracted using a template instrument from the JBI. DATA SYNTHESIS: The authors summarized the characteristics of the six included articles, synthesized outcomes, and compared similar articles. Honey and Plantago major dressings were the topical interventions that significantly reduced wound size. The literature suggests that the effect on wound healing of these natural products may be related to the presence of phenolic compounds. CONCLUSIONS: The studies included in this review show that natural products can positively impact the healing of PIs. However, there are limited controlled clinical trials addressing natural products and PIs in the literature.", "provenance": [ { "field": "population", "quote": "individuals with PIs" }, { "field": "intervention", "quote": "topical interventions of natural products applied to patients with PIs" }, { "field": "comparator", "quote": "individuals treated with topical natural products compared to a control treatment" }, { "field": "primaryOutcome", "quote": "outcomes with wound healing or wound reduction" }, { "field": "result", "quote": "Honey and Plantago major dressings were the topical interventions that significantly reduced wound size." }, { "field": "n", "quote": "Only six studies were included in this scoping review." } ] }, { "id": "pmid:36733220", "pmid": "36733220", "doi": "10.1002/bit.28341", "nctId": null, "pmcid": null, "title": "Electrospinning of honey and propolis for wound care", "firstAuthor": "Mele", "multipleAuthors": false, "journal": "Biotechnol Bioeng", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "People with skin wounds or burns (general context, not a specific study group)", "intervention": "Honey (including manuka honey) and propolis incorporated into electrospun nanofibre wound dressings", "comparator": "", "primaryOutcome": "How well these dressings fight bacteria and promote cell growth and tissue repair", "result": "The abstract reviews existing literature and discusses dressing effectiveness but does not give a specific quantitative result", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review about developing dressing technology, not a clinical study measuring actual wound healing outcomes in patients.", "directness": "indirect", "limitations": "No original patient data, no defined population or comparator, and no quantified outcomes are reported; it summarizes lab-level dressing development literature.", "followUp": "", "plainFinding": "Reviews honey dressing technology, no patient data.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36733220/", "sourceText": "Phytochemicals and naturally derived compounds, such as plant extracts and bee products, are regarded as complementary and alternative medicines for the treatment of skin wounds, due to their antibacterial, anti-inflammatory, and antioxidant properties. In recent years, it has been shown that dressings impregnated with honey (particularly Manuka honey) are effective for the topical treatment of wounds and burns, and some of them are currently used in clinics. This has stimulated the development of more advanced dressings based on polymeric nanofibres that can release honey and other bee products (like propolis) to promote wound healing. In this review, the current literature on the electrospinning of honey and propolis is analyzed and the effectiveness of the resulting dressings to inhibit bacterial growth and stimulate cellular proliferation and tissue repair is discussed.", "provenance": [ { "field": "intervention", "quote": "polymeric nanofibres that can release honey and other bee products (like propolis) to promote wound healing" }, { "field": "population", "quote": "wounds and burns" }, { "field": "primaryOutcome", "quote": "the effectiveness of the resulting dressings to inhibit bacterial growth and stimulate cellular proliferation and tissue repair" }, { "field": "result", "quote": "the effectiveness of the resulting dressings to inhibit bacterial growth and stimulate cellular proliferation and tissue repair is discussed" } ] }, { "id": "pmid:36598614", "pmid": "36598614", "doi": "10.1007/s10151-022-02740-8", "nctId": null, "pmcid": null, "title": "The value of honey dressings in pilonidal cyst healing: a prospective randomized single-center trial", "firstAuthor": "Abet", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2023, "design": "rct", "n": 100, "nField": "reported", "population": "patients with a wound after pilonidal cyst removal that hadn't healed and needed packing 6 weeks after surgery", "intervention": "alginate dressing plus honey", "comparator": "alginate dressing alone", "primaryOutcome": "time for the wound to heal", "result": "average healing time was 61 days with honey versus 78 days without, a difference that was not statistically significant", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but found no statistically significant difference and was conducted at a single center over many years", "directness": "indirect", "limitations": "did not reach significance in its primary endpoint; single center; long recruitment period from 2016-2022", "followUp": "", "plainFinding": "No significant difference in healing time.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36598614/", "sourceText": "BACKGROUND: Honey is described as a wound healing agent. Many virtues have been attributed to it, in particular, antibacterial properties. The aim of our study was to evaluate its value in healing of wounds after wide excision on pilonidal cyst healing. METHODS: A prospective randomized trial was conducted from March 2016 to February 2022 which included patients with a persistent non healed wound which required packing 6 weeks after pilonidal cyst excision. Patients were randomly allocated to simple alginate wick dressings or the same design plus honey. RESULTS: Fifty patients were included in each arm. There were 57 men and 43 women. The median age was 22 years (range 19-28 years). The mean healing time was 61 (± 44) days in the wick + honey group compared to 78 (± 55) days in the simple alginate wick group (p = 0.094). There was no significant difference between the two groups in terms of time off work and time without physical activity The VQ-Dermato quality of life score was equivalent in both groups. CONCLUSIONS: Tolerability for honey dressings is good and is equivalent to that of alginate dressings in cavity wound care. This trial did not reach a significant difference in its primary endpoint but it shows the value of honey in this indication, although its use requires further study. TRIAL REGISTRATION NUMBER: CLINICAL TRIALS: NCT02485860 and EUDRACT: 2015-A00452-47 (10/03/2015).", "provenance": [ { "field": "n", "quote": "Fifty patients were included in each arm." }, { "field": "population", "quote": "patients with a persistent non healed wound which required packing 6 weeks after pilonidal cyst excision" }, { "field": "intervention", "quote": "the same design plus honey" }, { "field": "comparator", "quote": "simple alginate wick dressings" }, { "field": "primaryOutcome", "quote": "The mean healing time was 61 (± 44) days in the wick + honey group compared to 78 (± 55) days in the simple alginate wick group (p = 0.094)." }, { "field": "result", "quote": "The mean healing time was 61 (± 44) days in the wick + honey group compared to 78 (± 55) days in the simple alginate wick group (p = 0.094)." } ] }, { "id": "pmid:35971015", "pmid": "35971015", "doi": "10.1007/s00264-022-05540-9", "nctId": null, "pmcid": "PMC9556393", "title": "Honey dressing: a missed way for orthopaedic wound care", "firstAuthor": "Ahmed", "multipleAuthors": true, "journal": "Int Orthop", "year": 2022, "design": "case-series", "n": 50, "nField": "reported", "population": "adults with orthopaedic wounds from open fractures, infected bone non-healing, or post-surgical infections", "intervention": "honey-soaked gauze dressing applied to the wound", "comparator": "none reported (no comparison group)", "primaryOutcome": "wound healing", "result": "All cases showed improvement with complete wound healing and full coverage of bone and tendons, with a few complications treated by further minor procedures", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small single-arm study with no comparison group, so it can't show whether honey worked better than standard care.", "directness": "indirect", "limitations": "No control or comparator group; single-arm prospective study; small sample size", "followUp": "", "plainFinding": "All wounds healed with honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35971015/", "sourceText": "PURPOSE: Orthopaedic-related wounds are critical situations calling for care to avoid deep infections and its consequences. The purpose of this study was to evaluate the efficacy of using honey for care of orthopaedic-related wounds with limited resources. PATIENTS AND METHODS: This prospective study included 50 cases with an average age of 38.18 (range 17-63) years with 38 males and 12 females. The most frequent wound location was the leg (41 patients; 82%), then the foot (six patients; 12%), and the ankle in three patients (6%). The aetiologies were open fractures (34 cases; 68%), infected tibial non-unions (nine cases; 18%), and post-operative infections (seven cases; 14%). Exposed tendon was present in three cases. Bone exposure was present in two cases. Deep infection was present in 29 cases (58%). Besides treating the primary cause, a ribbon of gauze soaked with honey was applied to the wounds after thorough saline washing. RESULTS: Wound sizes were variable. All cases showed improvement in all parameters with complete wound healing and full coverage of bone and tendons. Recurrence of deep infection occurred in three cases and treated by debridement. One case needed sequestrectomy of a small exposed tibial cortical fragment. Exposed tendon cases showed superficial necrosis which was treated by simple debridement. Initial mild itching occurred in five patients with spontaneous resolution. CONCLUSION: With treating the underlying aetiology and optimising the patient's general condition, honey was an effective, simple, and affordable method of wound care in different orthopaedic conditions even with exposed bone or tendons.", "provenance": [ { "field": "n", "quote": "This prospective study included 50 cases" }, { "field": "population", "quote": "The aetiologies were open fractures (34 cases; 68%), infected tibial non-unions (nine cases; 18%), and post-operative infections (seven cases; 14%)" }, { "field": "intervention", "quote": "a ribbon of gauze soaked with honey was applied to the wounds after thorough saline washing" }, { "field": "comparator", "quote": "Besides treating the primary cause, a ribbon of gauze soaked with honey was applied to the wounds" }, { "field": "primaryOutcome", "quote": "The purpose of this study was to evaluate the efficacy of using honey for care of orthopaedic-related wounds" }, { "field": "result", "quote": "All cases showed improvement in all parameters with complete wound healing and full coverage of bone and tendons." } ] }, { "id": "pmid:35930364", "pmid": "35930364", "doi": "10.1002/14651858.CD010738.pub2", "nctId": null, "pmcid": "PMC9354941", "title": "Hydrogel dressings for venous leg ulcers", "firstAuthor": "Ribeiro", "multipleAuthors": true, "journal": "Cochrane Database Syst Rev", "year": 2022, "design": "systematic-review", "n": 272, "nField": "reported", "population": "adults with venous leg ulcers", "intervention": "hydrogel wound dressing", "comparator": "gauze and saline, alginate dressing, manuka honey, or hydrocolloid dressing", "primaryOutcome": "complete wound healing and change in ulcer size", "result": "uncertain whether hydrogel differs from manuka honey or other dressings for healing, because evidence is very low certainty", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "Only small single trials with high risk of bias and imprecise results for each comparison, including the manuka honey one.", "directness": "indirect", "limitations": "High risk of bias in all trials, small sample sizes, incomplete reporting of variance data, and short follow-up periods.", "followUp": "four weeks in three studies and two weeks in one study; one study followed to 12 weeks after four weeks of treatment", "plainFinding": "No clear difference found versus honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35930364/", "sourceText": "BACKGROUND: Venous leg ulcers are a chronic health problem that cause considerable economic impact and affect quality of life for those who have them. Primary wound contact dressings are usually applied to ulcers beneath compression therapy to aid healing, promote comfort and control exudate. There are numerous dressing products available for venous leg ulcers and hydrogel is often prescribed for this condition; however, the evidence base to guide dressing choice is sparse. OBJECTIVES: To assess the effects of hydrogel wound dressings on the healing of venous leg ulcers in any care setting. SEARCH METHODS: In May 2021, we searched the Cochrane Wounds Specialised Register, CENTRAL, Ovid MEDLINE, Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies, reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included randomised controlled trials (RCTs), either published or unpublished, that compared the effects of hydrogel dressing with other dressings on the healing of venous leg ulcers. We excluded trials evaluating hydrogel dressings impregnated with antimicrobial, antiseptic or analgesic agents as these interventions are evaluated in other Cochrane Reviews. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included four RCTs (10 articles) in a qualitative analysis. Overall, 272 participants were randomised, in sample sizes ranging from 20 to 156 participants. The mean age of the included population in the trials ranged from 55 to 68 years, 37% were women based on studies that reported the sex of participants. The studies compared hydrogel dressings with the following: gauze and saline, alginate dressing, manuka honey and hydrocolloid. Two studies were multicentre and the others were single-centre trials. Length of treatment using hydrogel dressing was four weeks in three studies and two weeks in one study. The follow-up period was the same as the duration of treatment in three studies and in one study the follow-up for wound healing was at 12 weeks after four weeks of treatment. Overall risk of bias was high for all trials because at least one of the three key criteria (selection bias, detection bias and attrition bias) was at high risk. Hydrogel compared with gauze and saline It is uncertain whether there is a difference in complete wound healing (risk ratio (RR) 5.33, 95% confidence interval (CI) 1.73 to 16.42; 1 trial, 60 participants) or change in ulcer size (mean difference (MD) -1.50, 95% CI -1.86 to -1.14; 1 trial, 60 participants) between interventions because the certainty of the evidence is very low. Data reported from one trial were incomplete for time-to-ulcer healing. Hydrogel compared with alginate dressing It is uncertain whether there is a difference in change in ulcer size between hydrogel and alginate gel because the certainty of the evidence is very low (MD -41.80, 95% CI -63.95 to -19.65; 1 trial, 20 participants). Hydrogel compared with manuka honey It is uncertain whether there is a difference in complete wound healing (RR 0.75, 95% CI 0.46 to 1.21; 1 trial, 108 participants) or incidence of wound infection (RR 2.00, 95% CI 0.81 to 4.94; 1 trial, 108 participants) between interventions because the certainty of the evidence is very low. Hydrogel compared with hydrocolloid One study (84 participants) reported on change in ulcer size between hydrogel and hydrocolloid; however, further analysis was not possible because authors did not report standard errors or any other measurement of variance of a set of data from the means. Therefore, it is also uncertain whether there is a difference in change in ulcer size between hydrogel and hydrocolloid because the certainty of the evidence is very low. No studies provided evidence for the outcomes: recurrence of ulcer, health-related quality of life, pain and costs. Overall, independent of the comparison, the certainty of evidence is very low and downgraded twice due to risk of bias and once or twice due to imprecision for all comparisons and outcomes. AUTHORS' CONCLUSIONS: There is inconclusive evidence to determine the effectiveness of hydrogel dressings compared with gauze and saline, alginate dressing, manuka honey or hydrocolloid on venous leg ulcer healing. Practitioners may, therefore, consider other characteristics such as costs and symptom management when choosing between dressings. Any future studies assessing the effects of hydrogel on venous wound healing should consider using all the steps from CONSORT, and consider key points such as appropriate sample size with the power to detect expected differences, appropriate outcomes (such as time-to-event analysis) and adverse effects. If time-to-event analysis is not used, at least a longer follow-up (e.g. 12 weeks and above) should be adopted. Future studies should also address important outcomes that the studies we included did not investigate, such as health-related quality of life, pain and wound recurrence.", "provenance": [ { "field": "population", "quote": "Venous leg ulcers are a chronic health problem" }, { "field": "intervention", "quote": "hydrogel wound dressings" }, { "field": "comparator", "quote": "The studies compared hydrogel dressings with the following: gauze and saline, alginate dressing, manuka honey and hydrocolloid." }, { "field": "primaryOutcome", "quote": "To assess the effects of hydrogel wound dressings on the healing of venous leg ulcers" }, { "field": "result", "quote": "It is uncertain whether there is a difference in complete wound healing (RR 0.75, 95% CI 0.46 to 1.21; 1 trial, 108 participants) or incidence of wound infection (RR 2.00, 95% CI 0.81 to 4.94; 1 trial, 108 participants) between interventions because the certainty of the evidence is very low." }, { "field": "n", "quote": "Overall, 272 participants were randomised, in sample sizes ranging from 20 to 156 participants." } ] }, { "id": "pmid:35916823", "pmid": "35916823", "doi": "10.26355/eurrev_202207_29314", "nctId": null, "pmcid": null, "title": "Honey combined with silver ion dressing in complicated chronic wound of the scalp: a case report", "firstAuthor": "Lin", "multipleAuthors": true, "journal": "Eur Rev Med Pharmacol Sci", "year": 2022, "design": "case-series", "n": 1, "nField": "reported", "population": "13-year-old girl with a chronic non-healing scalp wound after brain surgery infection", "intervention": "honey combined with silver ion wound dressing", "comparator": "no comparator, prior treatment with repeated dressing changes and debridement that had failed", "primaryOutcome": "wound healing", "result": "wound fully healed after 6 months of honey plus silver dressing treatment, no recurrence after 10 months", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report with no comparison group, so it cannot show whether honey caused the healing.", "directness": "indirect", "limitations": "single case report, no control group, different wound type (scalp) and different population than anorectal surgery wounds", "followUp": "10 months", "plainFinding": "Chronic scalp wound finally healed.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35916823/", "sourceText": "OBJECTIVE: Scalp wound healing is a complex process. Nonhealing wounds can become chronic wounds, which increase the trauma and economic burden on a patient and may even cause death in severe cases. Thus, it can be difficult to find an effective treatment for chronic wounds of the scalp. CASE PRESENTATION: We present a case of a 13-year-old female patient with a chronic wound caused by a scalp incision infection 3 months after two operations for craniotomy for arachnoid cyst resection and cystic lesion-cisterna magna drainage. After repeated dressing changes and two debridement operations, the incision had still not healed during the following year. The wound finally healed after 6 months of dressing changes by combining honey with silver ion dressings, and the incision had not re-ruptured after 10 months of follow-up. CONCLUSIONS: Honey combined with silver may be an effective method for the treatment of chronic scalp wounds.", "provenance": [ { "field": "n", "quote": "a 13-year-old female patient with a chronic wound" }, { "field": "population", "quote": "a case of a 13-year-old female patient with a chronic wound caused by a scalp incision infection 3 months after two operations for craniotomy for arachnoid cyst resection and cystic lesion-cisterna magna drainage" }, { "field": "intervention", "quote": "combining honey with silver ion dressings" }, { "field": "comparator", "quote": "After repeated dressing changes and two debridement operations, the incision had still not healed during the following year." }, { "field": "primaryOutcome", "quote": "The wound finally healed after 6 months of dressing changes by combining honey with silver ion dressings" }, { "field": "result", "quote": "the incision had not re-ruptured after 10 months of follow-up" } ] }, { "id": "pmid:35797263", "pmid": "35797263", "doi": "10.12968/jowc.2022.31.7.548", "nctId": null, "pmcid": null, "title": "When time does not heal all wounds-the use of medical grade honey in wound healing: a case series", "firstAuthor": "Naik", "multipleAuthors": true, "journal": "J Wound Care", "year": 2022, "design": "case-series", "n": 6, "nField": "reported", "population": "patients with long-standing hard-to-heal wounds, many with other health problems and infected wounds", "intervention": "medical grade honey (L-Mesitran) applied to the wound, alone or alongside other treatment", "comparator": "the patients' own previous ineffective treatments", "primaryOutcome": "wound healing, infection control and quality of life (pain, odour, exudate)", "result": "wounds started healing, infection was controlled, and pain, odour and exudate improved", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a small series of just six patients with no comparison group, so it cannot show whether honey caused the improvement.", "directness": "indirect", "limitations": "no control group, only six cases, patients had differing wounds and comorbidities, and honey was sometimes combined with other therapy", "followUp": "", "plainFinding": "Hard-to-heal wounds healed faster.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35797263/", "sourceText": "OBJECTIVE: Hard-to-heal wounds can be caused by persistent infections or an excess of inflammatory cytokines, proteases and oxidants, and can severely impact the quality of life (QoL) of patients. Due to the paucity of effective treatments and increased resistance to antibiotics, new and improved therapies are required to resolve infections and to simultaneously enhance the healing trajectory. Medical grade honey (MGH) may be a novel and effective treatment approach. METHODS: In this case series, we have described six cases of hard-to-heal wounds, and discussed the effects of MGH on infection, wound healing and factors influencing patient QoL (pain, odour and exudate). In all cases, the wounds had persisted for a long period, and previous treatments had been ineffective. Most of the patients had comorbidities, and the majority of the wounds were contaminated with (multiresistant) bacteria, both of which contributed to non-healing. All wounds were treated with L-Mesitran (MGH-based wound care products, Triticum Exploitatie BV, the Netherlands) either as monotherapy or as a complementary therapy. RESULTS: Hard-to-heal wounds started healing, infection was controlled and QoL was strongly improved (malodour, exudate levels and pain swiftly decreased) after the application of the MGH. All wounds healed relatively quickly, considering the severity of the wounds and general health of the patients. CONCLUSION: In this study, MGH was a useful alternative or complementary therapy to antibiotics and expedited the healing of hard-to-heal wounds.", "provenance": [ { "field": "n", "quote": "we have described six cases of hard-to-heal wounds" }, { "field": "population", "quote": "Most of the patients had comorbidities, and the majority of the wounds were contaminated with (multiresistant) bacteria" }, { "field": "intervention", "quote": "All wounds were treated with L-Mesitran (MGH-based wound care products, Triticum Exploitatie BV, the Netherlands) either as monotherapy or as a complementary therapy." }, { "field": "comparator", "quote": "previous treatments had been ineffective" }, { "field": "primaryOutcome", "quote": "we have described six cases of hard-to-heal wounds, and discussed the effects of MGH on infection, wound healing and factors influencing patient QoL (pain, odour and exudate)" }, { "field": "result", "quote": "Hard-to-heal wounds started healing, infection was controlled and QoL was strongly improved (malodour, exudate levels and pain swiftly decreased) after the application of the MGH." } ] }, { "id": "pmid:35642400", "pmid": "35642400", "doi": null, "nctId": null, "pmcid": null, "title": "Effects of bee honey on promotion of peripheral nerve regeneration in an experimental model of nerve crush injury", "firstAuthor": "Belal", "multipleAuthors": true, "journal": "Pak J Pharm Sci", "year": 2022, "design": "animal", "n": 40, "nField": "reported", "population": "rats with crushed sciatic nerve injury", "intervention": "bee honey given locally or injected into the abdomen", "comparator": "injured rats given no honey treatment", "primaryOutcome": "recovery of nerve and muscle function and structure", "result": "honey-treated rats showed better nerve and muscle function and structure than untreated injured rats", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a small animal study on nerve injury, not a human wound-healing trial, so it offers only weak, indirect evidence for the question.", "directness": "indirect", "limitations": "animal model of nerve crush injury, not human surgical wound healing; small group sizes typical of such experiments; no mention of blinding or randomization", "followUp": "", "plainFinding": "Helped nerve healing in rats.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35642400/", "sourceText": "Peripheral nerve injuries are commonly encountered within clinical settings because of accidental trauma. This study aimed to examine the therapeutic effect of bee honey on peripheral nerve crush injury through a histological and physiological perspective. In this study, forty Wistar rats were divided into four groups. Rats were subjected to surgical operations to expose the sciatic nerve. Animals of the first group were operated without inducing any lesion to the nerve. The other three groups were subjected to induction of nerve crush injury. Two groups of them were treated with honey solution locally and intraperitoneally respectively. The other group served as injured nontreated group. Two physiological tests were performed to examine the living animals' nerve functions. At the end of the experimental period, the rats were sacrificed, and samples from the sciatic nerve and gastrocnemius muscle were obtained for histological, immunohistochemical and ultrastructural examination. Physiological indicators and structural investigations demonstrated considerable amelioration of the function and structure of nerves and muscles in the two treated groups compared with the injured nontreated group. The findings indicate that the bee honey has a curative effect on the peripheral nerve crush injury in the rat model.", "provenance": [ { "field": "n", "quote": "forty Wistar rats were divided into four groups" }, { "field": "population", "quote": "Animals of the first group were operated without inducing any lesion to the nerve. The other three groups were subjected to induction of nerve crush injury." }, { "field": "intervention", "quote": "Two groups of them were treated with honey solution locally and intraperitoneally respectively." }, { "field": "comparator", "quote": "The other group served as injured nontreated group." }, { "field": "primaryOutcome", "quote": "Physiological indicators and structural investigations demonstrated considerable amelioration of the function and structure of nerves and muscles" }, { "field": "result", "quote": "Physiological indicators and structural investigations demonstrated considerable amelioration of the function and structure of nerves and muscles in the two treated groups compared with the injured nontreated group." } ] }, { "id": "pmid:35568151", "pmid": "35568151", "doi": "10.1016/j.ijbiomac.2022.05.072", "nctId": null, "pmcid": null, "title": "Preparation of aloe polysaccharide/honey/PVA composite hydrogel: Antibacterial activity and promoting wound healing", "firstAuthor": "Zhang", "multipleAuthors": true, "journal": "Int J Biol Macromol", "year": 2022, "design": "lab", "n": null, "nField": "not-reported", "population": "infected full-thickness wounds in a lab model", "intervention": "a hydrogel combining aloe plant polysaccharide, honey, and PVA plastic", "comparator": "", "primaryOutcome": "how well the hydrogel fights bacteria and heals infected wounds", "result": "the hydrogel inhibited bacteria and yeast and sped up healing of infected wounds", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is early-stage lab testing of a multi-ingredient gel, not a clinical study in people, so it can't show whether honey itself helps real patients heal.", "directness": "indirect", "limitations": "no participant population, no comparator group described, honey type (e.g. manuka) not specified, and product combines honey with aloe and PVA rather than testing honey alone", "followUp": "", "plainFinding": "Honey gel sped healing in lab test", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35568151/", "sourceText": "Maintaining a moist and sterile environment is conducive to accelerating wound healing. To develop a natural wound dressing with good water retention capacity and antibacterial activity, we prepared a novel natural multifunctional hydrogel for infected wound healing, which combines the advantages of Aloe polysaccharide (AP) and honey. AP was extracted from Aloe barbadensis, and its structure was characterized by fourier transform infra-red (FT-IR) spectoscopy and nuclear magnetic resonance (NMR) spectroscopy. AP is an acetylated mannan composed of (1 → 4)β-Manp, which is acetylated at C-2, C-3 and C-6 positions. AP/Honey@PVA hydrogel was prepared by cross-linking AP, honey, PVA with borax, which has good mechanical strength and excellent biocompatibility for blood cells, NIH-3T3 cells and L929 cells. The hydrogels showed significant inhibitory effect on Staphylococcus aureus, Escherichia coli and Candida albicans, as well as accelerated the healing of infected full-thickness wound. This study reveals the structure of AP and proves that AP and honey composite hydrogel has potential application prospect in the therapy of infected wounds.", "provenance": [ { "field": "intervention", "quote": "AP/Honey@PVA hydrogel was prepared by cross-linking AP, honey, PVA with borax" }, { "field": "primaryOutcome", "quote": "The hydrogels showed significant inhibitory effect on Staphylococcus aureus, Escherichia coli and Candida albicans, as well as accelerated the healing of infected full-thickness wound." }, { "field": "result", "quote": "The hydrogels showed significant inhibitory effect on Staphylococcus aureus, Escherichia coli and Candida albicans, as well as accelerated the healing of infected full-thickness wound." }, { "field": "population", "quote": "accelerated the healing of infected full-thickness wound" } ] }, { "id": "pmid:35561469", "pmid": "35561469", "doi": "10.1016/j.ijscr.2022.107140", "nctId": null, "pmcid": "PMC9112025", "title": "The use of Indonesian randu honey for chronic wounds in a patient with uncontrolled type 2 diabetes mellitus: A case report", "firstAuthor": "Wahdini", "multipleAuthors": true, "journal": "Int J Surg Case Rep", "year": 2022, "design": "case-series", "n": 1, "nField": "reported", "population": "a man with uncontrolled type 2 diabetes and a severe chronic leg wound", "intervention": "Indonesian randu honey wound dressing combined with other wound care", "comparator": "no comparator, single patient case", "primaryOutcome": "complete wound closure", "result": "wound fully closed after 1.5 years of treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether honey caused the healing or reliably works for others", "directness": "indirect", "limitations": "single case, no control group, uses Indonesian randu honey not manuka honey, not anorectal surgery setting", "followUp": "1.5 years", "plainFinding": "Chronic wound eventually healed with honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35561469/", "sourceText": "INTRODUCTION AND IMPORTANCE: Honey has been recorded as having healing properties at a low cost. Many studies have been conducted related to Manuka honey, but studies about Indonesian randu honey are still limited. We report the use of Indonesian randu honey as a wound dressing on non-pressure chronic skin ulcers in uncontrolled T2DM patient. CASE PRESENTATION: A 54-year-old man with uncontrolled T2DM came with an unrecovered wound. A thorough inspection revealed several exposed bones, tendons, muscles, and meniscus in the left lower leg region. It was supposed to be amputated, but he declined. He received insulin, debridement, STSG, and a combination of Indonesian randu honey dressing and VAC on the exposed wound before and after the debridement and STSG. There was skin graft lysis, and we intended to do another surgery, but he preferred to be an outpatient. As an outpatient, he received honey wound dressing and insulin. After 1.5 years, the wound was fully closed, and he could walk with the help of a walking stick. CLINICAL DISCUSSION: Treatment for multiple exposed bones, tendons, and muscles in uncontrolled T2DM patient are complex. Studies reported that Indonesian honey could provide an antibacterial effect, cost-efficiency, speed up wound healing with no side effects, and no physical-chemical properties differences compared to Manuka honey. CONCLUSION: Using Indonesian randu honey as wound dressing could stimulate wound healing with no side effects in chronic wounds with uncontrolled T2DM that were supposed to be amputated. However, it took several months for the wound to fully close.", "provenance": [ { "field": "n", "quote": "A 54-year-old man with uncontrolled T2DM came with an unrecovered wound." }, { "field": "population", "quote": "A 54-year-old man with uncontrolled T2DM came with an unrecovered wound." }, { "field": "intervention", "quote": "a combination of Indonesian randu honey dressing and VAC on the exposed wound before and after the debridement and STSG" }, { "field": "comparator", "quote": "CASE PRESENTATION" }, { "field": "primaryOutcome", "quote": "After 1.5 years, the wound was fully closed" }, { "field": "result", "quote": "After 1.5 years, the wound was fully closed, and he could walk with the help of a walking stick." } ] }, { "id": "pmid:35503610", "pmid": "35503610", "doi": "10.26355/eurrev_202204_28595", "nctId": null, "pmcid": null, "title": "Effect of honey dressing material on palatal wound healing after harvesting a free gingival graft: a prospective randomized case control study", "firstAuthor": "Alasqah", "multipleAuthors": true, "journal": "Eur Rev Med Pharmacol Sci", "year": 2022, "design": "rct", "n": 20, "nField": "reported", "population": "patients who had a gum graft taken from the roof of the mouth", "intervention": "Medihoney dressing applied to the wound", "comparator": "no dressing applied", "primaryOutcome": "percentage of the donor site wound healed (width and length) over time", "result": "the honey-dressed wounds healed significantly more by week 1 and week 4 than the undressed wounds", "resultDirection": "benefit", "quality": "low", "qualityWhy": "very small study of only 20 people with no dressing as the comparison instead of a sham dressing, so bias is likely and results may not generalize.", "directness": "indirect", "limitations": "abstract does not describe blinding, and the comparator was no dressing at all rather than a placebo dressing", "followUp": "4 week", "plainFinding": "Faster wound healing with honey", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35503610/", "sourceText": "OBJECTIVE: The aim of this prospective randomized case-control study was to understand the clinical benefits and effect of honey as a dressing material on palatal wound healing after harvesting free gingival graft (FGG). PATIENTS AND METHODS: This prospective randomized case-control study was conducted on a sample of 20 patients with 10 patients in each group. Medihoney dressing material was applied to the donor site in the test group, whereas no dressing material was applied to the control group. All the patients received the same medication (Ibuprofen 600 mg) and post-operative instructions straight away after the surgical procedure. Patients were given the follow-up appointment at first, second and fourth week after the surgery during which the length and the width of the donor site was measured and recorded. RESULTS: At first week, a significant difference in the proportion of patients showing the healing of donor site percentage was found to be 56% (both in width and length) for test group vs. 44% (both in width and length) for the control group (p=0.001). At 4-week, the healing of donor site percentage was found to be 86% (in width) and 91% (in length) for test group vs. 14% (in width) and 9% (in length) for the control group, the difference being statistically significant (p=0.001). CONCLUSIONS: The result of this current study suggests that the honey dressing material accelerated the wound healing process of the palatal wound after harvesting FGG. It also showed a shorter recovery period along with less post-operative morbidity.", "provenance": [ { "field": "n", "quote": "a sample of 20 patients with 10 patients in each group" }, { "field": "population", "quote": "palatal wound healing after harvesting free gingival graft (FGG)" }, { "field": "intervention", "quote": "Medihoney dressing material was applied to the donor site in the test group" }, { "field": "comparator", "quote": "no dressing material was applied to the control group" }, { "field": "primaryOutcome", "quote": "the length and the width of the donor site was measured and recorded" }, { "field": "result", "quote": "At 4-week, the healing of donor site percentage was found to be 86% (in width) and 91% (in length) for test group vs. 14% (in width) and 9% (in length) for the control group, the difference being statistically significant (p=0.001)." } ] }, { "id": "pmid:35427872", "pmid": "35427872", "doi": "10.1016/j.drup.2022.100834", "nctId": null, "pmcid": null, "title": "Revolutionizing non-conventional wound healing using honey by simultaneously targeting multiple molecular mechanisms", "firstAuthor": "Pleeging", "multipleAuthors": true, "journal": "Drug Resist Updat", "year": 2022, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with wounds, including non-conventional uses like post colon surgery, mucositis, and tooth extraction", "intervention": "honey applied in novel ways (subcutaneous, intra-socket, abdominal, oral)", "comparator": "not specified", "primaryOutcome": "wound healing, infection prevention, inflammation, and pain", "result": "honey showed beneficial effects on healing, reduced inflammation, infection, and pain across various non-conventional applications", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a narrative review discussing mechanisms and summarizing other studies rather than presenting new controlled data, so it can't prove honey works for anorectal surgery wounds specifically.", "directness": "indirect", "limitations": "abstract does not report study designs, sample sizes, or specific results of the studies it reviews; variation between honey types is noted", "followUp": "", "plainFinding": "Honey may help wounds heal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35427872/", "sourceText": "Hospital-acquired infections and treatment-related wound complications constitute a tremendous burden for the health care system, particularly given the serious increase in multidrug resistant pathogens. Imagine that a large part of nosocomial infections can be prevented using a simple treatment. In this respect, honey is used mainly in topical cutaneous wound care because of its potent broad-spectrum antibacterial and wound healing activities. However, therapeutic use outside this scope has been limited. The current review provides an in-depth view of studies using honey outside the conventional wound care indications. Non-conventional routes of honey application include subcutaneous, intra-socket, abdominal, and oral administration in novel indications, such as post colon surgery, mucositis, and tooth extraction. Honey consistently demonstrates beneficial therapeutic activities in these novel applications, orchestrating antimicrobial and prophylactic activity, reducing inflammation and wound dehiscence, and inducing healing, epithelialization, and analgesic activity. Several molecular mechanisms are responsible for these beneficial clinical effects of honey during the course of wound healing. Pro-inflammatory effects of honey, such as induction of iNOS, IL-1β, and COX-2, are mediated by TLR4 signaling. In contrast, honey's anti-inflammatory actions and flavonoids induce anti-inflammatory and antioxidant pathways by inducing NRF2 target genes, including HO-1 and PRDX1. The molecular and biochemical pathways activated by honey during the different phases of wound healing are also discussed in more detail in this review. Variation between different honey origins exists, and therefore standardized medical-grade honey may offer an optimized and safe treatment. Honey is a valuable alternative to conventional antimicrobial and anti-inflammatory therapies that can strongly reduce nosocomial infections.", "provenance": [ { "field": "intervention", "quote": "Non-conventional routes of honey application include subcutaneous, intra-socket, abdominal, and oral administration in novel indications, such as post colon surgery, mucositis, and tooth extraction." }, { "field": "population", "quote": "novel indications, such as post colon surgery, mucositis, and tooth extraction" }, { "field": "primaryOutcome", "quote": "reducing inflammation and wound dehiscence, and inducing healing, epithelialization, and analgesic activity" }, { "field": "result", "quote": "Honey consistently demonstrates beneficial therapeutic activities in these novel applications, orchestrating antimicrobial and prophylactic activity, reducing inflammation and wound dehiscence, and inducing healing, epithelialization, and analgesic activity." }, { "field": "comparator", "quote": "Honey is a valuable alternative to conventional antimicrobial and anti-inflammatory therapies" } ] }, { "id": "pmid:35261292", "pmid": "35261292", "doi": "10.1177/10556656221086192", "nctId": null, "pmcid": null, "title": "Wound Healing Following Palatoplasty Using Either Honey or Warm Saline Mouth Bath for Postoperative Wound Care: A Randomized-Controlled Study", "firstAuthor": "Adekunle", "multipleAuthors": true, "journal": "Cleft Palate Craniofac J", "year": 2023, "design": "rct", "n": 50, "nField": "reported", "population": "people having cleft palate surgery", "intervention": "honey drops in the mouth after surgery", "comparator": "warm saline mouth rinse after surgery", "primaryOutcome": "complete healing (re-epithelisation) of the surgical wound in the mouth at 2 and 4 weeks", "result": "more people healed completely by 2 weeks with honey than with saline, but by 4 weeks all wounds had healed in both groups", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it was a randomized trial but small, from one hospital, used clinical observation rather than blinded assessment, and studied a different type of surgical wound than anorectal surgery.", "directness": "indirect", "limitations": "small sample size, single center, wound assessment was 'clinically observed' rather than objectively measured, and the honey type was not specified as manuka", "followUp": "4 weeks", "plainFinding": "Faster early healing, but no difference by 4 weeks", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35261292/", "sourceText": "OBJECTIVE: To evaluate and compare the effect of honey or saline mouth bath for wound care on the rate of re-epithelisation of the lateral palatal defects and occurrence of early postoperative complications following palatoplasty. METHODOLOGY: This was a prospective randomized study on participants with non-syndromic cleft palate conducted at a tertiary health institution in Lagos, Nigeria. The test group received oral honey drops for post-operative care for an initial period of two weeks post-surgery, while the control group had regular oral toileting using a warm saline solution. The primary outcome was epithelisation of lateral palatal defect at 2- and 4-weeks post repair. Descriptive and comparative statistics were computed, and the p-value was set at <0.05. RESULTS: Fifty participants were recruited into the study, 24 in the Test group and 26 in the Control group. The frequency of occurrence of oronasal fistula in the Test group was 4.0% while in the Control group was 10.0%, however, this was not statistically significant. Complete epithelisation of the lateral palatal defect was clinically observed in 66.7% of the participants in the Test group at 2 weeks post-operation, while only 38.5% of participants in the Control group had clinically observed complete epithelisation at the same time point (β = 1.70, p = .035, 95% CI 1.122-26.533). At four weeks, all wounds had epithelised irrespective of the study group. CONCLUSION: The application of honey appears to aid earlier epithelization of palatal surgical wounds following cleft palate repair and reduced the incidence of palatal fistula.", "provenance": [ { "field": "n", "quote": "Fifty participants were recruited into the study, 24 in the Test group and 26 in the Control group." }, { "field": "population", "quote": "participants with non-syndromic cleft palate" }, { "field": "intervention", "quote": "The test group received oral honey drops for post-operative care for an initial period of two weeks post-surgery" }, { "field": "comparator", "quote": "the control group had regular oral toileting using a warm saline solution" }, { "field": "primaryOutcome", "quote": "The primary outcome was epithelisation of lateral palatal defect at 2- and 4-weeks post repair." }, { "field": "result", "quote": "Complete epithelisation of the lateral palatal defect was clinically observed in 66.7% of the participants in the Test group at 2 weeks post-operation, while only 38.5% of participants in the Control group had clinically observed complete epithelisation at the same time point (β = 1.70, p = .035, 95% CI 1.122-26.533). At four weeks, all wounds had epithelised irrespective of the study group." } ] }, { "id": "pmid:35220733", "pmid": "35220733", "doi": "10.12968/bjon.2022.31.4.S8", "nctId": null, "pmcid": null, "title": "Treating surgical site infection by honey antibacterial wound dressing in a neonate: a case report", "firstAuthor": "Parizad", "multipleAuthors": true, "journal": "Br J Nurs", "year": 2022, "design": "case-series", "n": 1, "nField": "reported", "population": "a newborn baby with an infected surgical wound after tumor removal surgery", "intervention": "honey-containing antibacterial wound dressing (Medihoney)", "comparator": "previous treatment with saline dressings and antibiotics", "primaryOutcome": "wound healing", "result": "the infected wound fully healed after treatment with honey dressing", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report with no comparison group, so it cannot show whether honey caused the improvement.", "directness": "indirect", "limitations": "single case report, no control group, infection also received antibiotics before honey treatment", "followUp": "3 months", "plainFinding": "Wound fully healed after honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35220733/", "sourceText": "Surgical site infection (SSI) increases length of treatment, delays wound healing, increases antibiotic use and causes patient death in severe cases. This case was a boy aged 38 weeks and 4 days with a birthweight of 2100 g, a height of 42 cm and a head circumference of 32 cm. Twelve days after birth, he was admitted to hospital where a surgeon removed a sacrococcygeal teratoma. The surgical site became infected, and the infection failed to improve despite him receiving routine normal saline dressings twice a day and intravenous antibiotic therapy. The authors started treatment using an antibacterial wound dressing containing honey (Medihoney) on the SSI twice a day for a month. The infant's SSI was wholly healed after 3 months, and he was discharged from the wound treatment team in good general condition. This case shows that SSIs can be treated with honey-containing antibacterial wound gel, especially in infants who have weaker immune systems.", "provenance": [ { "field": "population", "quote": "This case was a boy aged 38 weeks and 4 days with a birthweight of 2100 g" }, { "field": "intervention", "quote": "antibacterial wound dressing containing honey (Medihoney) on the SSI twice a day for a month" }, { "field": "comparator", "quote": "routine normal saline dressings twice a day and intravenous antibiotic therapy" }, { "field": "primaryOutcome", "quote": "The infant's SSI was wholly healed after 3 months" }, { "field": "result", "quote": "The infant's SSI was wholly healed after 3 months, and he was discharged from the wound treatment team in good general condition" }, { "field": "n", "quote": "This case was a boy aged 38 weeks and 4 days" } ] }, { "id": "pmid:35199596", "pmid": "35199596", "doi": "10.12968/jowc.2022.31.3.230", "nctId": null, "pmcid": null, "title": "Treatment of Pasteurella multocida infection with dressings containing honey and antibacterials: a case report", "firstAuthor": "Hu", "multipleAuthors": true, "journal": "J Wound Care", "year": 2022, "design": "case-series", "n": 1, "nField": "reported", "population": "a woman with severe cellulitis and bone infection in her hand from a Pasteurella multocida infection, likely from a pet exposure", "intervention": "dressings containing honey plus antibiotics", "comparator": "earlier conventional wound dressings combined with antibiotics", "primaryOutcome": "wound healing", "result": "successfully treated and healed after switching to honey dressings with antibiotics", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report with no control group, so it cannot show whether honey itself caused the improvement", "directness": "indirect", "limitations": "only one patient, no comparison group, and the infection and wound type differ from anorectal surgical wounds", "followUp": "", "plainFinding": "Wound healed with honey dressings.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35199596/", "sourceText": "Infections secondary to Pasteurella multocida frequently occur in patients who have been exposed to domestic pets. Human infections caused by Pasteurella multocida vary in severity, and clinical features include localised cellulitis, osteomyelitis, systemic bacteraemia, meningitis and pneumonia. No vaccine has been developed against Pasteurella multocida; it is treated with antibacterial agents and, in most cases, surgical intervention. This article discusses the authors' experience in treating a woman with severe cellulitis and osteomyelitis on her hand caused by Pasteurella multocida. She refused surgical intervention and was successfully treated with honey-containing dressings and antibiotics after failure to heal following conservative treatment using conventional wound dressings combined with antibiotics.", "provenance": [ { "field": "n", "quote": "treating a woman with severe cellulitis and osteomyelitis on her hand caused by Pasteurella multocida" }, { "field": "population", "quote": "a woman with severe cellulitis and osteomyelitis on her hand caused by Pasteurella multocida" }, { "field": "intervention", "quote": "honey-containing dressings and antibiotics" }, { "field": "comparator", "quote": "conservative treatment using conventional wound dressings combined with antibiotics" }, { "field": "primaryOutcome", "quote": "successfully treated with honey-containing dressings and antibiotics after failure to heal" }, { "field": "result", "quote": "she refused surgical intervention and was successfully treated with honey-containing dressings and antibiotics after failure to heal following conservative treatment using conventional wound dressings combined with antibiotics" } ] }, { "id": "pmid:35097108", "pmid": "35097108", "doi": "10.1155/2022/1560050", "nctId": null, "pmcid": "PMC8799333", "title": "In Vitro Antibacterial Activity of Different Honey Samples against Clinical Isolates", "firstAuthor": "Wadi", "multipleAuthors": false, "journal": "Biomed Res Int", "year": 2022, "design": "lab", "n": 32, "nField": "reported", "population": "bacteria samples isolated from patients, not wound patients themselves", "intervention": "raw natural and commercial honey samples tested against bacteria", "comparator": "antibiotics (amoxicillin, ciprofloxacin, cefotaxime, chloramphenicol, gentamicin, tetracycline)", "primaryOutcome": "ability to stop bacteria growing in a lab dish", "result": "Honey stopped growth of all tested bacteria, while bacteria were less sensitive to antibiotics", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a lab dish test of bacteria, not a study of people with wounds, so it cannot show whether honey heals wounds.", "directness": "indirect", "limitations": "In vitro testing only on clinical bacterial isolates; no wound healing or patient outcomes assessed; no anorectal surgery context.", "followUp": "", "plainFinding": "Honey killed bacteria in lab dish.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35097108/", "sourceText": "BACKGROUND: The emergence of multi-drug-resistant organisms has created a lot of clinical problems. Hence, there is a need to find natural alternative treatment to counter the multi-drug-resistant organisms. Honey has a well-established usage as wound dressing in ancient and traditional medicine. OBJECTIVE: The objective of this study is to establish a baseline for the antibacterial activity of 32 global raw natural and commercial various honey samples against 8 clinical isolates. METHODS: Thirty-two honey samples (raw and commercial honey) collected from different global countries with different floral origins were tested in vitro for antibacterial activity against 8 clinical isolates collected from patients, at private hospital from Sudan, using disk diffusion technique. The following 6 epsilometer tests (Etest), amoxicillin, ciprofloxacin, cefotaxime, chloramphenicol, gentamicin, and tetracycline, were used against 8 clinical isolates for Minimum Inhibitory Concentration (MIC). RESULTS: The following 8 clinical isolates were identified by conventional bacteriological methods: Staphylococcus aureus, (S. aureus) Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), Pseudomonas aeruginosa (P. aeruginosa), Proteus vulgaris (P. vulgaris), Salmonella Typhi (S. Typhi), Shigella sonnei (S. sonnei), and methicillin-resistant Staphylococcus aureus (MRSA). Both raw natural and commercial honey exhibited antibacterial properties against tested Gram-positive and Gram-negative bacteria. The tested organisms showed low sensitivity to antibiotic Etest. CONCLUSION: All of the bacterial species studied were uniformly receptive to all raw and commercial tested honey samples; in contrast, the tested organisms showed low sensitivity to antibiotics. Commercial honey has the same antibacterial activity as the raw natural unprocessed honey against tested clinical isolates. Thus, honey is a successful alternative to conventional antibiotics as has been proved against clinical isolates.", "provenance": [ { "field": "population", "quote": "8 clinical isolates collected from patients, at private hospital from Sudan" }, { "field": "intervention", "quote": "Thirty-two honey samples (raw and commercial honey) collected from different global countries with different floral origins were tested in vitro for antibacterial activity against 8 clinical isolates" }, { "field": "comparator", "quote": "amoxicillin, ciprofloxacin, cefotaxime, chloramphenicol, gentamicin, and tetracycline" }, { "field": "primaryOutcome", "quote": "tested in vitro for antibacterial activity against 8 clinical isolates" }, { "field": "result", "quote": "All of the bacterial species studied were uniformly receptive to all raw and commercial tested honey samples; in contrast, the tested organisms showed low sensitivity to antibiotics." }, { "field": "n", "quote": "Thirty-two honey samples (raw and commercial honey) collected from different global countries" } ] }, { "id": "pmid:34968982", "pmid": "34968982", "doi": "10.1016/j.ijscr.2021.106672", "nctId": null, "pmcid": "PMC8717243", "title": "The application of honey in wound care of raw surface at spontaneous rupture submandibular abscess that extends to submental and right neck: A case report", "firstAuthor": "Saputri", "multipleAuthors": true, "journal": "Int J Surg Case Rep", "year": 2022, "design": "case-series", "n": 1, "nField": "reported", "population": "67-year-old man with a ruptured submandibular abscess wound extending to the neck", "intervention": "wound dressing with Nusantara honey (local Indonesian honey, not manuka)", "comparator": "no comparison group; before/after wound care", "primaryOutcome": "wound healing and infection improvement after necrotomy", "result": "improvement seen 10 days after necrotomy with no allergic reactions or secondary infections", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report with no comparison group, so it cannot show whether honey caused the improvement.", "directness": "indirect", "limitations": "single case, no control group, different honey type (Nusantara not manuka), different wound cause (neck abscess, not anorectal surgery), combined with antibiotics and surgery so honey's specific effect cannot be isolated", "followUp": "10 days after necrotomy", "plainFinding": "Wound improved, but no proof honey helped", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34968982/", "sourceText": "INTRODUCTION: Honey has been reported to accelerate wound healing. The use of honey in wound care mostly uses medicated (Manuka) honey. There are still few who report using Nusantara honey, local honey from Indonesia, as a wound dressing. We report wound care using Nusantara honey in patients with a remarkably open wound due to a ruptured submandibular abscess extending to the submental and right neck. PRESENTATION OF CASE: A 67 years old male patient came with a ruptured submandibular abscess that extends to the submental and right neck. On the right submandibular region, an ulcer extends to submental with a size of 10 × 4 × 3 cm, hyperemic, edema around the wound, fluctuating, with pus and tenderness. The isolated bacteria were Staphylococcus aureus. The patient received combination antibiotic therapy, blood sugar management, necrotomy debridement, tooth extraction, and wound care using Nusantara honey on the sixth day after surgery. An improvement was seen on the 10th day after necrotomy. DISCUSSION: The use of honey for wound care is based on thousands of years of history. Honey can accelerate wound healing and show different effects depending on the phase of wound healing. In addition, honey also has antibacterial properties. CONCLUSION: Applying Nusantara honey to treat raw surfaces can help speed up wound healing and provide cost-efficiency. There were no allergic reactions or secondary bacterial infections after using honey in this patient.", "provenance": [ { "field": "n", "quote": "A 67 years old male patient" }, { "field": "population", "quote": "A 67 years old male patient came with a ruptured submandibular abscess that extends to the submental and right neck." }, { "field": "intervention", "quote": "wound care using Nusantara honey on the sixth day after surgery" }, { "field": "comparator", "quote": "wound care using Nusantara honey on the sixth day after surgery" }, { "field": "primaryOutcome", "quote": "An improvement was seen on the 10th day after necrotomy." }, { "field": "result", "quote": "An improvement was seen on the 10th day after necrotomy." }, { "field": "result", "quote": "There were no allergic reactions or secondary bacterial infections after using honey in this patient." } ] }, { "id": "pmid:34756969", "pmid": "34756969", "doi": "10.1016/j.ijbiomac.2021.10.166", "nctId": null, "pmcid": null, "title": "Design, preparation and in vitro characterization of biomimetic and bioactive chitosan/polyethylene oxide based nanofibers as wound dressings", "firstAuthor": "Ionescu", "multipleAuthors": true, "journal": "Int J Biol Macromol", "year": 2021, "design": "lab", "n": null, "nField": "not-reported", "population": "not applicable (laboratory material testing, not human patients)", "intervention": "chitosan/polyethylene oxide nanofiber wound dressings with added manuka honey, propolis, calendula, insulin, or arginine", "comparator": "different nanofiber formulations compared to each other (propolis+calendula version singled out as best)", "primaryOutcome": "physical, biodegradation, blood compatibility, toxicity, antioxidant and antimicrobial properties of the nanofiber material in the lab", "result": "the propolis and calendula combination nanofiber performed best in lab tests; manuka honey was only one of several tested additives and not shown to be superior", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is early-stage lab testing of a material, not a study on actual wounds or patients, so it cannot show whether manuka honey helps healing in people", "directness": "indirect", "limitations": "purely in vitro/material characterization work with no animal or human wound data, and no patients or surgery involved at all", "followUp": "", "plainFinding": "Lab material test, not a healing study", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34756969/", "sourceText": "Chitosan-based nanofibers (CS-NFs) are excellent artificial extracellular matrices (ECMs) due to the resemblance of CS with the glycosaminoglycans of the natural ECMs. Despite this excellent feature, the poor electrospinnability and mechanical properties of CS are responsible for important limitations in respect to its biomedical applications. To improve the CS's physico-chemical properties, new bioactive and biomimetic CS-NFs were formulated with polyethylene oxide (PEO), having incorporated different active components (ACs) with important beneficial effects for healing. Manuka honey (trophic and antimicrobial effects), propolis (antimicrobial effects), Calendula officinalis infusion (antioxidant effect, reepithelialization stimulating agent), insulin (trophic effect), and L-arginine (angiogenic effect) were selected as ACs. SEM morphology analysis revealed well-alignment, unidirectional arrays, with small diameters, no beads, and smooth surfaces for developed CS_PEO-ACs NFs. The developed NFs showed good biodegradability (NFs mats lost up to 60% of their initial weight in PBS), increased hemocompatibility (hemolytic index less than 4%), and a reduced cytotoxicity degree (cell viability degree more than 90%). In addition, significant antioxidant and antimicrobial effects were noted for the developed NFs which make them suitable for chronic wounds, due to the role of oxidative stress and infection risk in delaying normal wound healing. The most suitable for wound healing applications seems to be CS_PEO@P_C which showed an improved hemolysis index (2.92 ± 0.16%), is non-toxic (cell viability degree more than 97%), and has also significant radical scavenging effect (DPPH inhibition more than 65%). In addition, CS_PEO@P_C presents increased antimicrobial effects, more noticeably for Staphylococcus aureus strain, which is a key feature in preventing wound infection and delaying the healing process. It can be concluded that the developed CS/PEO-ACs NFs are very promising biomaterials for wound care, especially CS_PEO@P_C.", "provenance": [ { "field": "population", "quote": "SEM morphology analysis revealed well-alignment, unidirectional arrays, with small diameters, no beads, and smooth surfaces for developed CS_PEO-ACs NFs." }, { "field": "intervention", "quote": "Manuka honey (trophic and antimicrobial effects), propolis (antimicrobial effects), Calendula officinalis infusion (antioxidant effect, reepithelialization stimulating agent), insulin (trophic effect), and L-arginine (angiogenic effect) were selected as ACs." }, { "field": "comparator", "quote": "The most suitable for wound healing applications seems to be CS_PEO@P_C which showed an improved hemolysis index (2.92 ± 0.16%), is non-toxic (cell viability degree more than 97%), and has also significant radical scavenging effect (DPPH inhibition more than 65%)." }, { "field": "primaryOutcome", "quote": "The developed NFs showed good biodegradability (NFs mats lost up to 60% of their initial weight in PBS), increased hemocompatibility (hemolytic index less than 4%), and a reduced cytotoxicity degree (cell viability degree more than 90%)." }, { "field": "result", "quote": "In addition, CS_PEO@P_C presents increased antimicrobial effects, more noticeably for Staphylococcus aureus strain, which is a key feature in preventing wound infection and delaying the healing process." } ] }, { "id": "pmid:34756413", "pmid": "34756413", "doi": "10.1016/j.injury.2021.10.019", "nctId": null, "pmcid": null, "title": "Efficacy of topical honey compared to systemic gentamicin for treatment of infected war wounds in a porcine model: A non-inferiority experimental pilot study", "firstAuthor": "Muhrbeck", "multipleAuthors": true, "journal": "Injury", "year": 2022, "design": "animal", "n": 50, "nField": "reported", "population": "infected wounds in pigs", "intervention": "Manuka honey applied to wound surface", "comparator": "gentamicin given as muscle injection", "primaryOutcome": "bacterial count and wound size after treatment", "result": "honey did not reduce bacteria or wound size, while gentamicin reduced wound size but not sustained bacteria reduction", "resultDirection": "no-benefit", "quality": "very-low", "qualityWhy": "This was a small pilot study in just two pigs, so it can't tell us much about effects in humans.", "directness": "indirect", "limitations": "Only two pigs used, animal model not human, short treatment duration of eight days", "followUp": "eight days", "plainFinding": "No benefit over antibiotic for wounds.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34756413/", "sourceText": "BACKGROUND: In armed conflicts, infected wounds constitute a large portion of the surgical workload. Treatment consists of debridements, change of dressings, and antibiotics. Many surgeons advocate for the use of honey as an adjunct with the rationale that honey has bactericidal and hyperosmotic properties. However, according to a Cochrane review from 2015 there is insufficient data to draw any conclusions regarding the efficacy of honey in treatment of wounds. We, therefore, decided to evaluate if honey is non-inferior to gentamicin in the treatment of infected wounds in a highly translatable porcine wound model. MATERIAL AND METHODS: 50 standardized wounds on two pigs were infected with S. aureus and separately treated with either topically applied Manuka honey or intramuscular gentamicin for eight days. Treatment efficacy was evaluated with quantitative cultures, wound area measurements, histological, immunohistochemical assays, and inflammatory response. RESULTS: Topically applied Manuka honey did not reduce bacterial count or wound area for the duration of treatment. Intramuscular gentamicin initially reduced bacterial count (geometric mean 5.59*¸0.37 - 4.27*¸0.80 log10 (GSD) CFU/g), but this was not sustained for the duration of the treatment. However, wound area was significantly reduced with intramuscular gentamicin at the end of treatment (mean 112.8 ± 30.0-67.7 ± 13.2 (SD) mm2). ANOVA-analysis demonstrated no variation in bacterial count for the two treatments but significant variation in wound area (p<0.0001). The inflammatory response was more persistent in the pig with wounds treated with topically applied Manuka honey than in the pig treated with intramuscular gentamicin. CONCLUSION: At the end of treatment S. aureus count was the same with topically applied Manuka honey and intramuscular gentamicin. The wound area was unchanged with topically applied Manuka honey and decreased with intramuscular gentamicin. Topically applied Manuka honey could consequently be non-inferior to intramuscular gentamicin in reducing S. aureus colonization on the wound's surface, but not in reducing wound size. The use of Manuka honey dressings to prevent further progression of a wound infection may therefore be of value in armed conflicts, where definite care is not immediately available.", "provenance": [ { "field": "population", "quote": "50 standardized wounds on two pigs were infected with S. aureus" }, { "field": "intervention", "quote": "topically applied Manuka honey" }, { "field": "comparator", "quote": "intramuscular gentamicin" }, { "field": "primaryOutcome", "quote": "Treatment efficacy was evaluated with quantitative cultures, wound area measurements, histological, immunohistochemical assays, and inflammatory response." }, { "field": "result", "quote": "Topically applied Manuka honey did not reduce bacterial count or wound area for the duration of treatment." }, { "field": "result", "quote": "wound area was significantly reduced with intramuscular gentamicin at the end of treatment" }, { "field": "n", "quote": "50 standardized wounds on two pigs" } ] }, { "id": "pmid:34483582", "pmid": "34483582", "doi": "10.4103/njms.NJMS_154_20", "nctId": null, "pmcid": "PMC8386265", "title": "Manuka honey: A promising wound dressing material for the chronic nonhealing discharging wounds: A retrospective study", "firstAuthor": "Kapoor", "multipleAuthors": true, "journal": "Natl J Maxillofac Surg", "year": 2021, "design": "case-series", "n": 15, "nField": "reported", "population": "patients with chronic nonhealing discharging wounds on the face/mouth area", "intervention": "manuka honey applied directly to the wound along with antibiotics", "comparator": "none (no comparison group, wounds assessed before and after treatment)", "primaryOutcome": "change in wound depth and discharge over time", "result": "wound depth decreased markedly and wounds fully healed over with skin by 4 weeks", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "small retrospective study with no comparison group, so improvement cannot be separated from natural healing or other treatments given alongside honey.", "directness": "indirect", "limitations": "retrospective design with no control group, small sample size of 15 patients, and honey was given together with antibiotics making it hard to isolate its effect.", "followUp": "4 weeks", "plainFinding": "Wounds healed well with honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34483582/", "sourceText": "OBJECTIVES: To assess the efficacy and feasibility of topical manuka honey application in chronic nonhealing discharging extraoral wounds. MATERIALS AND METHODS: The study includes 15 patients (9 males and 6 females, mean age: 38.06, range: 20-50 years), presenting with the complaint of chronic nonhealing discharging extraoral wounds from January 2018 to January 2020. After wound irrigation with normal saline, manuka honey in conjunction with the antibiotic treatment was directly applied onto the surface of the wound and was then covered by an absorbent layer to contain the honey. Dressings were changed every alternate day for a week till there was complete cessation of pus discharge. Henceforth, the interval between dressings was increased to 1 week subsequently and was continued for 4 weeks. Assessment was done on the basis of discharge and depth of the wound before the procedure and weekly for 4 weeks. RESULTS: The average depth of wound as seen at 15 sites after a week was 5.72 mm, and decrease in the average depth of wound seen at the end of the 4th week was 0.88 mm with complete wound epithelization. This was found to be statistically significant (P = 0.0001). No cases were reported with allergy, pain, infection, inflammation, and swelling on 1st, 2nd, 3rd, and 4thweek. CONCLUSION: Hence, the use of manuka honey as a wound dressing material in our study has proved to promote the growth of tissues for wound repair, suppress inflammation, and bring about rapid autolytic debridement.", "provenance": [ { "field": "n", "quote": "The study includes 15 patients (9 males and 6 females, mean age: 38.06, range: 20-50 years)" }, { "field": "population", "quote": "chronic nonhealing discharging extraoral wounds" }, { "field": "intervention", "quote": "manuka honey in conjunction with the antibiotic treatment was directly applied onto the surface of the wound" }, { "field": "comparator", "quote": "Assessment was done on the basis of discharge and depth of the wound before the procedure and weekly for 4 weeks." }, { "field": "primaryOutcome", "quote": "Assessment was done on the basis of discharge and depth of the wound before the procedure and weekly for 4 weeks." }, { "field": "result", "quote": "The average depth of wound as seen at 15 sites after a week was 5.72 mm, and decrease in the average depth of wound seen at the end of the 4th week was 0.88 mm with complete wound epithelization. This was found to be statistically significant (P = 0.0001)." } ] }, { "id": "pmid:34468038", "pmid": "34468038", "doi": "10.1111/vsu.13711", "nctId": null, "pmcid": null, "title": "The effects of a proprietary Manuka honey and essential oil hydrogel on the healing of acute full-thickness wounds in dogs", "firstAuthor": "Repellin", "multipleAuthors": true, "journal": "Vet Surg", "year": 2021, "design": "animal", "n": 10, "nField": "reported", "population": "healthy adult female beagle dogs with surgically created wounds", "intervention": "Manuka honey and essential oil hydrogel dressing (HoneyCure)", "comparator": "standard-of-care dressing", "primaryOutcome": "wound healing measured by contraction, epithelialization, and histology", "result": "Epithelialization was slightly higher with honey gel at some time points but wound contraction and histology scores did not differ, and overall no evidence supported benefit", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "Small animal study with only 10 dogs, not directly testing human surgical wounds.", "directness": "indirect", "limitations": "Small sample size of healthy purpose-bred dogs with small acute wounds, may not reflect clinical wounds in humans or anorectal surgery.", "followUp": "21 days", "plainFinding": "No real healing benefit shown.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34468038/", "sourceText": "OBJECTIVE: To evaluate the effect of a proprietary Manuka honey essential oil hydrogel on the healing of acute, full-thickness wounds in dogs. STUDY DESIGN: Prospective, controlled, randomized, experimental study. ANIMALS: Purpose-bred, adult, female beagles (n = 10). METHODS: Two 2 × 2 cm surgical wounds were created bilaterally on the trunk of each dog; each side was randomized to receive HoneyCure® (HOC) or standard-of-care (CON) dressings. Cranial wounds were for histopathological analysis and the caudal wounds for culture and planimetry. Total and open wound areas were measured with digital image planimetry at 15 time points. From these data, percent contraction and percent epithelialization were calculated. Tissue biopsies were obtained at 7 time points and histologic features scored. Cultures were obtained at 2 time points. RESULTS: Epithelialization was 11.7, 10.4, and 10.1 percentage points higher in HOC wounds compared to CON wounds at days 16, 18, and 21 respectively. Wound contraction and histological scores did not differ between groups. Cultures were positive in 7/40 (17.5%) wounds, with Staphylococcus pseudintermedius and Staphylococcus epidermidis isolated evenly. There was no difference of infection rate between the two groups; all infections were superficial and did not require treatment. CONCLUSION: This study did not provide evidence to support the application of HoneyCure® in small, acute wounds in healthy dogs. However, application may be beneficial in the early proliferative stage of wound healing and in wounds that would benefit from early, robust epithelialization.", "provenance": [ { "field": "population", "quote": "Purpose-bred, adult, female beagles (n = 10)" }, { "field": "intervention", "quote": "HoneyCure® (HOC)" }, { "field": "comparator", "quote": "standard-of-care (CON) dressings" }, { "field": "primaryOutcome", "quote": "percent contraction and percent epithelialization" }, { "field": "result", "quote": "Epithelialization was 11.7, 10.4, and 10.1 percentage points higher in HOC wounds compared to CON wounds at days 16, 18, and 21 respectively. Wound contraction and histological scores did not differ between groups." }, { "field": "n", "quote": "Purpose-bred, adult, female beagles (n = 10)" }, { "field": "result", "quote": "This study did not provide evidence to support the application of HoneyCure® in small, acute wounds in healthy dogs." } ] }, { "id": "pmid:33856925", "pmid": "33856925", "doi": "10.12968/jowc.2021.30.Sup4.S28", "nctId": null, "pmcid": null, "title": "Comparison of topical honey and povidone iodine-based dressings for wound healing: a systematic review and meta-analysis", "firstAuthor": "Zhang", "multipleAuthors": true, "journal": "J Wound Care", "year": 2021, "design": "meta-analysis", "n": 1236, "nField": "reported", "population": "people with wounds (mixed types, not specified as anorectal surgery)", "intervention": "honey-based wound dressings (type of honey not specified as manuka)", "comparator": "povidone iodine-based wound dressings", "primaryOutcome": "time to wound healing, length of hospital stay, and pain score", "result": "Honey dressings showed a medium-to-large improvement in healing time, hospital stay, and pain scores compared with povidone iodine dressings", "resultDirection": "benefit", "quality": "low", "qualityWhy": "It pools 12 different studies on wounds of unspecified types without stating the honey was manuka or that any involved anorectal surgery, so it may not reflect this specific question.", "directness": "indirect", "limitations": "The abstract does not specify the type of honey used, the types of wounds included, or give a risk-of-bias assessment of the included studies.", "followUp": "", "plainFinding": "Honey healed wounds faster than iodine.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33856925/", "sourceText": "OBJECTIVES: In this review and meta-analysis, we analyse the evidence to compare the efficacy of honey and povidone iodine-based dressings on the outcome of wound healing. METHOD: A systematic literature search was performed using PRISMA guidelines in academic databases including MEDLINE, Scopus, Embase and CENTRAL. A meta-analysis was carried out to assess the effect of honey and povidone iodine-based dressings on mean healing duration, mean hospital stay duration and visual analogue scale (VAS) score of pain. RESULTS: From the search, 12 manuscripts with a total of 1236 participants (mean age: 40.7±11.7 years) were included. The honey-based dressings demonstrated a medium-to-large effect in reduction of mean healing duration (Hedge's g: -0.81), length of hospital stay (-3.1) and VAS score (-1.2) as compared with the povidone iodine-based dressings. We present evidence (level 1b) in favour of using honey for improvement of wound recovery as compared with povidone iodine. CONCLUSION: This review and meta-analysis demonstrate beneficial effects of honey-based dressings over povidone iodine-based dressings for wound recovery.", "provenance": [ { "field": "n", "quote": "12 manuscripts with a total of 1236 participants" }, { "field": "intervention", "quote": "honey and povidone iodine-based dressings" }, { "field": "comparator", "quote": "povidone iodine-based dressings" }, { "field": "primaryOutcome", "quote": "mean healing duration, mean hospital stay duration and visual analogue scale (VAS) score of pain" }, { "field": "result", "quote": "The honey-based dressings demonstrated a medium-to-large effect in reduction of mean healing duration (Hedge's g: -0.81), length of hospital stay (-3.1) and VAS score (-1.2) as compared with the povidone iodine-based dressings." }, { "field": "population", "quote": "wound healing" } ] }, { "id": "pmid:33852467", "pmid": "33852467", "doi": "10.1097/01.ASW.0000741532.29113.78", "nctId": null, "pmcid": null, "title": "Diabetic Foot Amputation Prevention During COVID-19", "firstAuthor": "Shankhdhar", "multipleAuthors": false, "journal": "Adv Skin Wound Care", "year": 2021, "design": "case-series", "n": 1, "nField": "reported", "population": "man with a diabetic foot ulcer that became infected", "intervention": "medical-grade honey-based wound dressing plus antibiotics, guided remotely", "comparator": "none", "primaryOutcome": "complete wound healing", "result": "the wound fully healed within 4 weeks", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report with no comparison group, so it cannot show whether honey caused the healing.", "directness": "indirect", "limitations": "single case report, remote/telephone-guided care during lockdown, combined with antibiotics so honey's individual effect cannot be separated, and this is a diabetic foot ulcer not anorectal surgery wounds.", "followUp": "4 weeks", "plainFinding": "Foot ulcer fully healed with honey dressing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33852467/", "sourceText": "In this case report, the treatment of a patient with a diabetic foot ulcer on his left foot was interrupted by the novel coronavirus 2019 pandemic lockdown in India. The author guided the patient via telephone and online services. Based on the history given by the patient, the lesion started as blistering from improperly fitted footwear that then evolved into multiple infected ulcerations on the dorsal surface of the great toe (osteomyelitis with septic arthritis of the joint). Based on a radiograph and other photographs of the foot lesions, the author prescribed amoxicillin/clavulanic acid in combination with linezolid for 2 weeks. Further, the author guided the patient to dress the wound at home using a medical-grade honey-based product. With no option for an outpatient visit, the author guided the patient to use a plastic ruler and place it below the toe during each dressing. Healing (complete epithelialization) was achieved within 4 weeks.", "provenance": [ { "field": "population", "quote": "the treatment of a patient with a diabetic foot ulcer on his left foot was interrupted by the novel coronavirus 2019 pandemic lockdown in India" }, { "field": "intervention", "quote": "the author guided the patient to dress the wound at home using a medical-grade honey-based product" }, { "field": "comparator", "quote": "the author prescribed amoxicillin/clavulanic acid in combination with linezolid for 2 weeks" }, { "field": "primaryOutcome", "quote": "Healing (complete epithelialization) was achieved within 4 weeks." }, { "field": "result", "quote": "Healing (complete epithelialization) was achieved within 4 weeks." }, { "field": "n", "quote": "the treatment of a patient with a diabetic foot ulcer" } ] }, { "id": "pmid:33852461", "pmid": "33852461", "doi": "10.1097/01.ASW.0000741508.83558.ce", "nctId": null, "pmcid": null, "title": "Manuka Honey: Feasibility and Safety in Postoperative Neurosurgical Wound Care", "firstAuthor": "Felbaum", "multipleAuthors": true, "journal": "Adv Skin Wound Care", "year": 2021, "design": "case-series", "n": 25, "nField": "reported", "population": "postoperative neurosurgical patients with nonhealing or at-risk wounds after cranial or spinal surgery", "intervention": "topical application of active Leptospermum manuka honey (ALH) gel or ointment once a day for 2 to 4 weeks", "comparator": "no comparison group", "primaryOutcome": "whether wounds required operative debridement and whether the honey was safe to use", "result": "7 of 25 patients still needed operative debridement and long-term antibiotics; no patient-reported adverse events occurred", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small, uncontrolled case series from a single surgeon with no comparison group, so it cannot show whether the honey actually helped healing.", "directness": "indirect", "limitations": "Retrospective, single-surgeon, no control group, small sample size, and population is neurosurgical (cranial/spinal) rather than anorectal surgery patients.", "followUp": "", "plainFinding": "Seemed safe, benefit unclear, no control group.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33852461/", "sourceText": "OBJECTIVE: To date, no reports have been published on active Leptospermum manuka honey (ALH) feasibility as a postoperative topical wound supplement in neurosurgical patients. The objective of the study is to present the authors' initial experience with using ALH in postoperative neurosurgical patients. METHODS: A single-surgeon retrospective case series review of cranial and spinal operations between 2018 and 2020 was performed in patients with nonhealing wounds or wounds deemed \"at risk\" as defined by grade 1 Sandy surgical wound dehiscence grading classification. An ALH gel or ointment was applied to these incisions once a day for 2 to 4 weeks. Patients were followed up in the clinic every 2 weeks until incisions had healed. RESULTS: Twenty-five postoperative patients (12 cranial, 13 spinal) were identified to be at high risk of operative debridement. All 25 patients were prescribed a topical application of ALH, which was easily adopted without patient-related adverse events. Seven (four cranial, three spinal) patients required operative debridement and treatment with long-term antibiotic therapy. CONCLUSIONS: In this small case series of neurosurgical patients who were at risk of poor wound healing, the application of medical-grade ALH was well tolerated without patient-reported adverse events. The ALH may have prevented the need for operative debridement in the majority of patients. Further prospective studies are necessary to establish its efficacy in wound healing in the neurosurgical population.", "provenance": [ { "field": "n", "quote": "Twenty-five postoperative patients (12 cranial, 13 spinal) were identified to be at high risk of operative debridement." }, { "field": "population", "quote": "cranial and spinal operations between 2018 and 2020 was performed in patients with nonhealing wounds or wounds deemed \"at risk\"" }, { "field": "intervention", "quote": "An ALH gel or ointment was applied to these incisions once a day for 2 to 4 weeks." }, { "field": "comparator", "quote": "A single-surgeon retrospective case series review" }, { "field": "primaryOutcome", "quote": "Seven (four cranial, three spinal) patients required operative debridement and treatment with long-term antibiotic therapy." }, { "field": "result", "quote": "All 25 patients were prescribed a topical application of ALH, which was easily adopted without patient-related adverse events. Seven (four cranial, three spinal) patients required operative debridement and treatment with long-term antibiotic therapy." } ] }, { "id": "pmid:33427815", "pmid": "33427815", "doi": "10.1097/WON.0000000000000712", "nctId": null, "pmcid": null, "title": "Successful Treatment of a Venous Leg Ulcer With Manuka Honey: A Case Study", "firstAuthor": "Mosteiro-Miguéns", "multipleAuthors": true, "journal": "J Wound Ostomy Continence Nurs", "year": 2021, "design": "case-series", "n": 1, "nField": "reported", "population": "a 76-year-old man with multiple venous leg ulcers that had not healed with other treatments", "intervention": "Manuka honey applied to the wound along with compression therapy", "comparator": "his own prior unsuccessful treatments (iodized cadexomer ointment, hydrodetersive fiber dressings, hydrocolloid meshes, compression therapy, antibiotics)", "primaryOutcome": "complete healing (epithelialization) of the wound and wound-related pain", "result": "the main ulcer fully healed within 38 days of starting Manuka honey, and pain improved within 17 days", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report with no comparison group, so it cannot show whether honey caused the improvement.", "directness": "indirect", "limitations": "single patient, no control group, cannot rule out natural healing or effect of continued compression therapy", "followUp": "38 days", "plainFinding": "Stubborn leg ulcer healed with honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33427815/", "sourceText": "BACKGROUND: Refractory venous leg ulcers (VLUs) often require extended time to heal, and they carry a high risk of recurrence. This case study describes our experiences with a patient with a VLU refractory to multiple treatment strategies who was successfully treated with Manuka honey. CASE: Mr S. was a 76-year-old man with multiple comorbid conditions and hypersensitivity to silver-based compounds, who developed 3 VLUs of his right lower extremity. He experienced 90 days of unsuccessful treatments using an iodized cadexomer ointment, hydrodetersive fiber dressings, hydrocolloid meshes, compression therapy, and antibiotic treatment without progression toward wound healing. We then initiated treatment with Manuka honey and continued compression therapy. His primary VLU was completely epithelialized within 38 days, and an adjacent VLU also showed progression toward healing. Mr S. reported clinically relevant improvement in wound-related pain at 17 days. CONCLUSION: The use of Manuka honey proved effective in this patient with a VLU refractory to other treatment strategies.", "provenance": [ { "field": "population", "quote": "Mr S. was a 76-year-old man with multiple comorbid conditions and hypersensitivity to silver-based compounds, who developed 3 VLUs of his right lower extremity." }, { "field": "intervention", "quote": "We then initiated treatment with Manuka honey and continued compression therapy." }, { "field": "comparator", "quote": "He experienced 90 days of unsuccessful treatments using an iodized cadexomer ointment, hydrodetersive fiber dressings, hydrocolloid meshes, compression therapy, and antibiotic treatment without progression toward wound healing." }, { "field": "primaryOutcome", "quote": "His primary VLU was completely epithelialized within 38 days, and an adjacent VLU also showed progression toward healing." }, { "field": "result", "quote": "His primary VLU was completely epithelialized within 38 days, and an adjacent VLU also showed progression toward healing. Mr S. reported clinically relevant improvement in wound-related pain at 17 days." }, { "field": "n", "quote": "Mr S. was a 76-year-old man" } ] }, { "id": "pmid:33331704", "pmid": "33331704", "doi": null, "nctId": null, "pmcid": null, "title": "[Use of honey dressings in wound healing]", "firstAuthor": "Nizet", "multipleAuthors": true, "journal": "Rev Med Liege", "year": 2020, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with wounds", "intervention": "medical graded honey dressings", "comparator": "not reported", "primaryOutcome": "wound healing", "result": "honey seems to be an effective therapeutic agent in wound healing", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a narrative article describing properties of honey dressings, not a study with data, so it offers very weak evidence.", "directness": "indirect", "limitations": "Abstract does not report any study design, population size, or comparative data; it is descriptive of properties and prior literature.", "followUp": "", "plainFinding": "Honey may help wounds heal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33331704/", "sourceText": "Honey is used as therapeutic in traditional medicine for a long time ago for a wide range of wounds. It has known a revival in modern care since the bacterial resistance against antibiotics appeared. Honey is known to have antibacterial activity, enhance wound healing and modulate immune response. While biological processes and bioactive compounds aren't well understood, honey seems to be an effective therapeutic agent in wound healing. Medical graded honey dressings were recently developed. The present article describes properties of medical graded honey dressings and their use for wound healing.", "provenance": [ { "field": "intervention", "quote": "Medical graded honey dressings were recently developed." }, { "field": "result", "quote": "honey seems to be an effective therapeutic agent in wound healing" }, { "field": "primaryOutcome", "quote": "their use for wound healing" }, { "field": "population", "quote": "wide range of wounds" }, { "field": "comparator", "quote": "The present article describes properties of medical graded honey dressings and their use for wound healing." } ] }, { "id": "pmid:33243953", "pmid": "33243953", "doi": "10.4103/aam.aam_53_19", "nctId": null, "pmcid": "PMC8015949", "title": "Treatment of recalcitrant chronic leg ulcer in a known sickle cell anaemia patient using honey and fresh hbaa red cell concentrate in a Nigerian secondary healthcare facility", "firstAuthor": "Nwagu", "multipleAuthors": true, "journal": "Ann Afr Med", "year": 2020, "design": "case-series", "n": 1, "nField": "reported", "population": "young adult with sickle cell anemia and chronic leg ulcer", "intervention": "local honey wound dressing plus blood transfusion", "comparator": "no comparator, single case", "primaryOutcome": "wound healing of chronic leg ulcer", "result": "wound fully closed after 4 months of treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report with no comparison group, so it cannot show whether honey actually caused the improvement.", "directness": "indirect", "limitations": "Single case report, combined treatment with blood transfusion makes it impossible to isolate honey's effect, no control group.", "followUp": "4 months", "plainFinding": "Leg ulcer healed with honey treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33243953/", "sourceText": "Sickle hemoglobin (HbS) formed by the point mutation in the genetic code of beta-globin chain leading to valine substituting glutamic acid at position 6 of the beta-chain. The resultant sickle cell disease (SCD) characterized by occlusion of microvasculature by red blood cells is associated with multiple organ pathologies. One of such complications is chronic leg ulcers. We report a case of chronic leg ulcer, in a known sickle cell anemia patient, which did not respond to the wound dressing methods at the hospital's disposal. The ulcer was successfully treated using standard operative procedure (S.O.P) in wound care, applying local honey, and use of blood transfusion. EA was a 20-year-old university undergraduate who was admitted to April 2019 in Central Hospital Benin City with chronic leg ulcer of 1 year duration. She was also anemic with hemoglobin concentration of 3.0 g/dl (packed cell volume 15%). The wound was dressed with local honey, and anemia corrected with blood transfusion using concentrated red cells lacking the HbS trait. There was a progressive improvement in the healing of the ulcer with total closure after 4 months of treatment. Maintenance and follow-up measures were instituted to prevent reoccurrence. This report showed that honey has remarkable properties in promoting wound healing. Its usage in combination with transfusion of HbA red blood cells to manage chronic leg ulcers in SCD patients is advocated. However, this calls for further studies and research.", "provenance": [ { "field": "n", "quote": "EA was a 20-year-old university undergraduate" }, { "field": "population", "quote": "a known sickle cell anemia patient, which did not respond to the wound dressing methods" }, { "field": "intervention", "quote": "The wound was dressed with local honey, and anemia corrected with blood transfusion using concentrated red cells lacking the HbS trait." }, { "field": "comparator", "quote": "We report a case of chronic leg ulcer" }, { "field": "primaryOutcome", "quote": "There was a progressive improvement in the healing of the ulcer with total closure after 4 months of treatment." }, { "field": "result", "quote": "total closure after 4 months of treatment" } ] }, { "id": "pmid:33181730", "pmid": "33181730", "doi": "10.1097/PCC.0000000000002611", "nctId": null, "pmcid": null, "title": "Use of Honey Versus Standard Care for Hospital-Acquired Pressure Injury in Critically Ill Children: A Multicenter Randomized Controlled Trial", "firstAuthor": "Sankar", "multipleAuthors": true, "journal": "Pediatr Crit Care Med", "year": 2021, "design": "rct", "n": 99, "nField": "reported", "population": "critically ill children aged 2 months to 17 years with pressure injury wounds in a pediatric ICU", "intervention": "medicated manuka (Leptospermum) honey dressing on the wound", "comparator": "standard routine wound care", "primaryOutcome": "time to complete wound healing", "result": "Median healing time was 7 days with honey versus 9 days with standard care, a statistically significant difference", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It was a well-designed randomized trial but open-label, in a different population (hospitalized children with pressure sores, not anorectal surgery patients), limiting how directly it applies.", "directness": "indirect", "limitations": "Open-label design (not blinded), small sample size, and population differs from anorectal surgery wounds.", "followUp": "", "plainFinding": "Faster wound healing with honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33181730/", "sourceText": "OBJECTIVES: To examine if the use of honey (medicated) for dressing is superior to standard care in terms of time to complete wound healing in stages 1-3 of pressure injuries in children admitted to the PICU. DESIGN: Multicenter, open-label, parallel-group, randomized trial. SETTING: Tertiary-care PICU from August 2017 to January 2019. PATIENTS: Critically ill children, 2 months to 17 years old, who developed pressure injury (stages 1-3) were included; those on more than two inotropes or with signs of acute wound infection or wounds with greater than 5 cm diameter or known allergy to honey were excluded. INTERVENTIONS: Children were randomized to receive either medicated honey dressing or standard (routine) wound care for the management of their pressure injury. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the time to complete wound healing. Manuka or active Leptospermum honey dressing/gel was used in the intervention group. Enrolled children were followed up until death or discharge from the hospital. A total of 99 children were enrolled: 51 in the intervention group and 48 in the standard care group. Baseline characteristics, including the nutritional status, were comparable between the groups. The most common sites of injury were bony prominences at face mask contact points. The median time to complete healing was 7 days (95% CI, 6-7 d) versus 9 days (7-10 d) in the intervention and standard care groups, respectively (p = 0.002; log-rank test). At any random time, children in the intervention group were about 1.9-fold more likely to have their pressure injury completely healed than those in the standard care group (hazard ratio 1.86; 95% CI, 1.21-2.87). There were no allergic reactions or secondary wound infections in the intervention group. CONCLUSIONS: The use of medicated honey dressings decreased the time to wound healing in critically ill children with pressure injuries. There were no allergic reactions or secondary bacterial infections in any of these children.", "provenance": [ { "field": "n", "quote": "A total of 99 children were enrolled: 51 in the intervention group and 48 in the standard care group." }, { "field": "population", "quote": "Critically ill children, 2 months to 17 years old, who developed pressure injury (stages 1-3) were included" }, { "field": "intervention", "quote": "Manuka or active Leptospermum honey dressing/gel was used in the intervention group." }, { "field": "comparator", "quote": "Children were randomized to receive either medicated honey dressing or standard (routine) wound care" }, { "field": "primaryOutcome", "quote": "The primary outcome was the time to complete wound healing." }, { "field": "result", "quote": "The median time to complete healing was 7 days (95% CI, 6-7 d) versus 9 days (7-10 d) in the intervention and standard care groups, respectively (p = 0.002; log-rank test)." } ] }, { "id": "pmid:33142845", "pmid": "33142845", "doi": "10.3390/antibiotics9110766", "nctId": null, "pmcid": "PMC7693943", "title": "Clinical Significance of Manuka and Medical-Grade Honey for Antibiotic-Resistant Infections: A Systematic Review", "firstAuthor": "Nolan", "multipleAuthors": true, "journal": "Antibiotics (Basel)", "year": 2020, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "bacteria samples including multidrug-resistant strains tested in laboratory studies, not patients", "intervention": "manuka and other medical-grade honeys applied directly to bacteria in lab experiments", "comparator": "different types of honey compared against each other and against bacterial strains", "primaryOutcome": "how well honey stopped bacterial growth (minimum inhibitory concentration) in lab tests", "result": "all honeys tested strongly inhibited bacterial growth regardless of whether the bacteria were drug-resistant, with Surgihoney the most potent", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a lab-based review of bacteria in dishes, not a study of wounds healing in actual patients.", "directness": "indirect", "limitations": "Abstract reports in-vitro antimicrobial susceptibility testing only; no patient wound-healing outcomes, no clinical trial data, no mention of anorectal surgery.", "followUp": "", "plainFinding": "Honey kills bacteria in lab tests.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33142845/", "sourceText": "Antimicrobial resistance is an ever-increasing global issue that has the potential to overtake cancer as the leading cause of death worldwide by 2050. With the passing of the \"golden age\" of antibiotic discovery, identifying alternative treatments to commonly used antimicrobials is more important than ever. Honey has been used as a topical wound treatment for millennia and more recently has been formulated into a series of medical-grade honeys for use primarily for wound and burn treatment. In this systematic review, we examined the effectiveness of differing honeys as an antimicrobial treatment against a variety of multidrug-resistant (MDR) bacterial species. We analysed 16 original research articles that included a total of 18 different types of honey against 32 different bacterial species, including numerous MDR strains. We identified that Surgihoney was the most effective honey, displaying minimum inhibitory concentrations as low as 0.1% (w/v); however, all honeys reviewed showed a high efficacy against most bacterial species analysed. Importantly, the MDR status of each bacterial strain had no impact on the susceptibility of the organism to honey. Hence, the use of honey as an antimicrobial therapy should be considered as an alternative approach for the treatment of antibiotic-resistant infections.", "provenance": [ { "field": "population", "quote": "32 different bacterial species, including numerous MDR strains" }, { "field": "intervention", "quote": "the effectiveness of differing honeys as an antimicrobial treatment against a variety of multidrug-resistant (MDR) bacterial species" }, { "field": "comparator", "quote": "18 different types of honey against 32 different bacterial species" }, { "field": "primaryOutcome", "quote": "displaying minimum inhibitory concentrations as low as 0.1% (w/v)" }, { "field": "result", "quote": "all honeys reviewed showed a high efficacy against most bacterial species analysed" }, { "field": "result", "quote": "the MDR status of each bacterial strain had no impact on the susceptibility of the organism to honey" } ] }, { "id": "pmid:33121306", "pmid": "33121306", "doi": "10.1177/1534734620968378", "nctId": null, "pmcid": null, "title": "Preliminary Clinical Evaluation Using a Novel Bioengineered Wound Product to Treat Lower Extremity Ulcers", "firstAuthor": "Rodriguez", "multipleAuthors": true, "journal": "Int J Low Extrem Wounds", "year": 2023, "design": "case-series", "n": 12, "nField": "reported", "population": "patients with lower extremity ulcers, including diabetic foot ulcers", "intervention": "a bioengineered wound product made of gelatin, Manuka honey, and hydroxyapatite applied to the wound", "comparator": "none - no control group, compared to patients' own prior standard of care", "primaryOutcome": "wound closure (healing of the ulcer)", "result": "9 of 12 patients achieved 100% wound closure within 8 weeks, with mean closure time of 4.1 weeks and 94% mean closure at 4 weeks", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a tiny uncontrolled case series of only 12 patients with no comparison group, so it cannot show whether the product itself caused the healing.", "directness": "indirect", "limitations": "No control group, very small sample (12 patients), described as a 'preliminary clinical evaluation'", "followUp": "8 weeks", "plainFinding": "Faster healing in diabetic foot ulcers.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33121306/", "sourceText": "Diabetes mellitus affects hundreds of millions of people worldwide, each of which have up to a 25% risk of developing a diabetic foot ulcer (DFU) during their lifetime. With poor DFU healing rates using standard of care, advanced treatments are introduced to attempt to close the wound. The objective of this preliminary clinical evaluation was to evaluate lower extremity ulcers treated with a novel bioengineered wound product (BWP). The BWP, a solid absorbable and conformable sheet composed of gelatin, Manuka honey, and hydroxyapatite, was applied on 12 patients with lower extremity ulcers. The patients in this evaluation spanned across 4 sites and had complicated medical histories, including little to no progression of healing with standard of care or treatment with other biomaterials. The ulcers were treated with debridement, BWP placement, dressing, appropriate compression, and offloading as necessary. Weekly follow-up visits were recommended for evaluation, debridement, and BWP reapplication. Nine patients had the BWP applied to aid in full closure. These patients achieved 100% closure within 8 weeks, with a mean closure time of 4.1 weeks. At 4 weeks, the mean percent wound closure was 94%. Three patients had the BWP applied to aid in achieving a healthy wound bed for continued treatment (eg, splitthickness skin graft) and to cover (epithelialization over) an exposed tendon. In all 12 cases, no treatment site infections were observed. The results and observations from this preliminary clinical evaluation suggest that the BWP supports rapid wound closure, a predictor of complete healing for DFUs.", "provenance": [ { "field": "population", "quote": "12 patients with lower extremity ulcers" }, { "field": "intervention", "quote": "a solid absorbable and conformable sheet composed of gelatin, Manuka honey, and hydroxyapatite" }, { "field": "comparator", "quote": "little to no progression of healing with standard of care or treatment with other biomaterials" }, { "field": "primaryOutcome", "quote": "evaluate lower extremity ulcers treated with a novel bioengineered wound product" }, { "field": "result", "quote": "These patients achieved 100% closure within 8 weeks, with a mean closure time of 4.1 weeks. At 4 weeks, the mean percent wound closure was 94%." }, { "field": "n", "quote": "applied on 12 patients with lower extremity ulcers" }, { "field": "followUp", "quote": "achieved 100% closure within 8 weeks" } ] }, { "id": "pmid:32764604", "pmid": "32764604", "doi": "10.1038/s41598-020-70186-9", "nctId": null, "pmcid": "PMC7414039", "title": "Manuka honey microneedles for enhanced wound healing and the prevention and/or treatment of Methicillin-resistant Staphylococcus aureus (MRSA) surgical site infection", "firstAuthor": "Frydman", "multipleAuthors": true, "journal": "Sci Rep", "year": 2020, "design": "lab", "n": null, "nField": "not-reported", "population": "Laboratory cell/bacterial models, not human patients", "intervention": "Manuka honey microneedles (MHMs), synthesized using different methods including vacuum-treatment", "comparator": "Cooked honey microneedles and different honey concentrations", "primaryOutcome": "Bacteria killing (MRSA) and speed of wound closure in lab assays", "result": "Manuka honey microneedles killed MRSA bacteria and vacuum-prepared honey showed a trend toward faster wound closure than cooked honey", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is early lab testing on cells and bacteria, not a study in patients, so it can't show whether this helps real wounds heal.", "directness": "indirect", "limitations": "In vitro only; no human or animal wound-healing model tested; wound closure differences described only as a trend, not statistically confirmed in the abstract.", "followUp": "", "plainFinding": "Lab study: honey microneedles killed MRSA, aided closure.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32764604/", "sourceText": "Manuka honey (MH) is currently used as a wound treatment and suggested to be effective in Methicillin-resistant Staphylococcus aureus (MRSA) elimination. We sought to optimize the synthesis of MH microneedles (MHMs) while maintaining the MH therapeutic effects. MHMs were synthesized using multiple methods and evaluated with in vitro assays. MHMs demonstrated excellent bactericidal activity against MRSA at concentrations ≥ 10% of honey, with vacuum-prepared honey appearing to be the most bactericidal, killing bacterial concentrations as high as 8 × 107 CFU/mL. The wound-healing assay demonstrated that, at concentrations of 0.1%, while the cooked honey had incomplete wound closure, the vacuum-treated honey trended towards faster wound closure. In this study, we demonstrate that the method of MHM synthesis is crucial to maintaining MH properties. We optimized the synthesis of MHMs and demonstrated their potential utility in the treatment of MRSA infections as well as in wound healing. This is the first report of using MH as a substrate for the formation of dissolvable microneedles. This data supports the need for further exploration of this new approach in a wound-healing model and opens the door for the future use of MH as a component of microneedle scaffolds.", "provenance": [ { "field": "population", "quote": "evaluated with in vitro assays" }, { "field": "intervention", "quote": "MHMs were synthesized using multiple methods and evaluated with in vitro assays" }, { "field": "comparator", "quote": "while the cooked honey had incomplete wound closure, the vacuum-treated honey trended towards faster wound closure" }, { "field": "primaryOutcome", "quote": "The wound-healing assay demonstrated that, at concentrations of 0.1%, while the cooked honey had incomplete wound closure, the vacuum-treated honey trended towards faster wound closure" }, { "field": "result", "quote": "MHMs demonstrated excellent bactericidal activity against MRSA at concentrations ≥ 10% of honey, with vacuum-prepared honey appearing to be the most bactericidal, killing bacterial concentrations as high as 8 × 107 CFU/mL" } ] }, { "id": "pmid:32691500", "pmid": "32691500", "doi": "10.1002/jbm.b.34690", "nctId": null, "pmcid": null, "title": "Production of a novel poly(ɛ-caprolactone)-methylcellulose electrospun wound dressing by incorporating bioactive glass and Manuka honey", "firstAuthor": "Schuhladen", "multipleAuthors": true, "journal": "J Biomed Mater Res B Appl Biomater", "year": 2021, "design": "lab", "n": null, "nField": "not-reported", "population": "human skin cells (dermal fibroblasts and keratinocyte-like cells) in lab tests", "intervention": "wound dressing fibers made of PCL-methylcellulose combined with Manuka honey and bioactive glass", "comparator": "", "primaryOutcome": "wound closure support and antibacterial activity in lab tests", "result": "the honey/glass fiber mats supported wound closure in cell tests but antibacterial performance needs further optimization", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "This is an early-stage lab material science study using cells, not patients, so it cannot show whether honey helps real wounds heal.", "directness": "indirect", "limitations": "No human or animal wound testing; only material characterization and cell culture experiments were performed.", "followUp": "", "plainFinding": "Lab material shows wound-healing potential.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32691500/", "sourceText": "Wound dressings produced by electrospinning exhibit a fibrous structure close to the one of the extracellular matrix of the skin. In this article, electrospinning was used to fabricate fiber mats based on the well-known biopolymers poly(ɛ-caprolactone) (PCL) and methylcellulose (MC) using benign solvents. The blend fiber mats were cross-linked using Manuka honey and additionally used as a biodegradable platform to deliver bioactive glass particles. It was hypothesized that a dual therapeutic effect can be achieved by combining Manuka honey and bioactive glass. Morphological and chemical examinations confirmed the successful production of submicrometric PCL-MC fiber mats containing Manuka honey and bioactive glass particles. The multifunctional fiber mats exhibited improved wettability and suitable mechanical properties (ultimate tensile strength of 3-5 MPa). By performing dissolution tests using simulated body fluid, the improved bioactivity of the fiber mats by the addition of bioactive glass was confirmed. Additionally, cell biology tests using human dermal fibroblasts and human keratinocytes-like HaCaT cells showed the potential of the fabricated composite fiber mats to be used as wound dressing, specially due to the ability to support wound closure influenced by the presence of bioactive glass. Moreover, based on the results of the antibacterial tests, it is apparent that an optimization of the electrospun fiber mats is required to develop suitable wound dressing for the treatment of infected wounds.", "provenance": [ { "field": "population", "quote": "cell biology tests using human dermal fibroblasts and human keratinocytes-like HaCaT cells" }, { "field": "intervention", "quote": "blend fiber mats were cross-linked using Manuka honey and additionally used as a biodegradable platform to deliver bioactive glass particles" }, { "field": "primaryOutcome", "quote": "ability to support wound closure influenced by the presence of bioactive glass" }, { "field": "result", "quote": "showed the potential of the fabricated composite fiber mats to be used as wound dressing, specially due to the ability to support wound closure influenced by the presence of bioactive glass" }, { "field": "result", "quote": "based on the results of the antibacterial tests, it is apparent that an optimization of the electrospun fiber mats is required to develop suitable wound dressing for the treatment of infected wounds" } ] }, { "id": "pmid:32675576", "pmid": "32675576", "doi": "10.1097/ANC.0000000000000781", "nctId": null, "pmcid": null, "title": "Medical-Grade Honey for the Treatment of Extravasation-Induced Injuries in Preterm Neonates: A Case Series", "firstAuthor": "Smaropoulos", "multipleAuthors": true, "journal": "Adv Neonatal Care", "year": 2021, "design": "case-series", "n": 7, "nField": "reported", "population": "premature newborn babies with IV fluid leakage injuries", "intervention": "medical-grade honey applied to wounds", "comparator": "none (no comparison group)", "primaryOutcome": "wound healing and closure", "result": "all wounds healed and closed within 7 to 67 days, with no infections detected", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this was a tiny uncontrolled case series with no comparison group, so it cannot show honey worked better than standard care.", "directness": "indirect", "limitations": "no control group, very small number of patients, different population (preterm neonates with IV injuries, not surgical anorectal wounds)", "followUp": "", "plainFinding": "Wounds healed, no infections seen.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32675576/", "sourceText": "INTRODUCTION: Preterm neonates often depend on peripheral intravenous administration of nutrition and medication. Since their skin is not fully developed and very vulnerable, extravasation injury is a risk. Medical-grade honey (MGH) possesses antimicrobial activity and stimulates wound healing; although its use in neonatal patients is limited. CLINICAL FINDINGS: We present a case series of 7 preterm neonates (28-36 weeks of gestation) with extravasation injuries secondary to peripheral intravenous administration of total parental nutrition and medication. PRIMARY DIAGNOSIS: Extravasation injury following the unintentional leakage of total parenteral nutrition, and medication into the surrounding tissue. Signs of extravasation include local pain, erythema, burning, pruritus, and/or swelling. INTERVENTIONS: All extravasation injuries were treated with daily cleaning and application of MGH. Some of the cases needed additional surgical intervention or assisted debridement. OUTCOMES: After treatment, all extravasation injury wounds presented with granulation tissue formation progressed to normal epithelialization and closed in 7 to 67 days (median: 32 days). Upon initial application, peripheral edema and inflammation decreased. When present, necrotic tissue was effectively debrided, slough was removed, and no signs of infection were detected, irrespective of initial wound presentations. Cicatrization was minimal, and the full range of motion was preserved in all cases. PRACTICE RECOMMENDATIONS: Continuous and thorough assessment of peripheral intravenous line placement for malposition, leaking, and signs of extravasation is needed for fast discovery and prevention of further damage. CONCLUSION: Medical-grade honey possesses antimicrobial, anti-inflammatory, and antioxidative activity, enhancing wound healing. Medical-grade honey was safe and effective for treating extravasation-induced injuries, independent of location and severity. We recommend MGH for treating extravasation wounds and consideration for other types of wounds.", "provenance": [ { "field": "population", "quote": "7 preterm neonates (28-36 weeks of gestation) with extravasation injuries" }, { "field": "intervention", "quote": "treated with daily cleaning and application of MGH" }, { "field": "comparator", "quote": "Some of the cases needed additional surgical intervention or assisted debridement." }, { "field": "primaryOutcome", "quote": "all extravasation injury wounds presented with granulation tissue formation progressed to normal epithelialization and closed" }, { "field": "result", "quote": "closed in 7 to 67 days (median: 32 days)" }, { "field": "result", "quote": "no signs of infection were detected, irrespective of initial wound presentations" }, { "field": "n", "quote": "We present a case series of 7 preterm neonates" } ] }, { "id": "pmid:32530778", "pmid": "32530778", "doi": "10.12968/jowc.2020.29.6.321", "nctId": null, "pmcid": null, "title": "Traditional and advanced therapeutic modalities for wounds in the paediatric population: an evidence-based review", "firstAuthor": "McNamara", "multipleAuthors": true, "journal": "J Wound Care", "year": 2020, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "children and newborns with non-healing wounds from various causes", "intervention": "various wound care treatments including dressings, topical remedies and skin substitutes", "comparator": "", "primaryOutcome": "", "result": "the review discusses several treatments like amniotic membrane grafts, Helicoll, and negative pressure wound therapy, but does not report specific findings for manuka honey beyond listing it as a search term", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a broad narrative review that searched databases but did not systematically analyze or report results for manuka honey specifically, and the authors state high-tier evidence in children is scarce overall.", "directness": "indirect", "limitations": "abstract states 'high tier evidence in these populations is scarce' and that 'RCTs involving larger sample sizes are necessary'; manuka honey is only mentioned as a search term, not discussed with specific results", "followUp": "", "plainFinding": "No manuka honey findings reported", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32530778/", "sourceText": "OBJECTIVE: Children can have non-healing wounds due to a wide range of pathologies, including epidermolysis bullosa (EB), pilonidal disease and Stevens-Johnson syndrome, with some causes being iatrogenic, including extravasation injuries and medical device-related hospital-acquired pressure ulcers. Furthermore, paediatric wounds are vastly different from adult wounds and therefore require a different treatment approach. While there are numerous types of dressings, topical remedies, and matrices with high-tier evidence to support their use in adults, evidence is scarce in the neonatal and paediatric age groups. The purpose of this review is to discuss the basic principles in paediatric wound management, as well as to present new treatment findings published in the literature to date. The benefits and risks of using different types of debridement are discussed in this review. Various topical formulations are also described, including the need to use antibiotics judiciously. METHOD: Databases were searched for relevant sources including Pubmed, Embase, Web of Science and DynaMed. Search terms used included 'wound care', 'wound management', 'paediatrics', 'children', 'skin substitutes', and 'grafts'. Additionally, each treatment and disease entity was searched for relevant sources, including, for example: 'Apligraf', 'dermagraft', 'Manuka honey', 'antibiotic', 'timolol', and 'negative pressure wound therapy' (NPWT). RESULTS: Amniotic membrane living skin equivalent is a cellular matrix that has been reportedly successful in treating paediatrics wounds and is currently under investigation in randomised clinical trials. Helicoll is an acellular matrix, which shows promise in children with recessive dystrophic EB. NPWT may be used as a tool to accelerate wound closure in children; however, caution must be taken due to limited evidence to support its safety and efficacy in the paediatric patient population. Integra has been reported as a useful adjunctive treatment to NPWT as both may act synergistically. Hospitalised children and neonates frequently have pressure ulcers, which is why prevention in this type of wound is paramount. CONCLUSION: Advancements in wound care are rapidly expanding. Various treatments for non-healing wounds in paediatric and neonatal patients have been reported, but high tier evidence in these populations is scarce. We hope to shed light on existing evidence regarding the different therapeutic modalities, from debridement techniques and dressing types to tissue substitutes and topical remedies. There have been promising results in many studies to date, but RCTs involving larger sample sizes are necessary, in order to determine the specific role these innovative agents play in paediatric wounds and to identify true safety and efficacy.", "provenance": [ { "field": "population", "quote": "Children can have non-healing wounds due to a wide range of pathologies, including epidermolysis bullosa (EB), pilonidal disease and Stevens-Johnson syndrome" }, { "field": "intervention", "quote": "'Apligraf', 'dermagraft', 'Manuka honey', 'antibiotic', 'timolol', and 'negative pressure wound therapy' (NPWT)" }, { "field": "result", "quote": "Amniotic membrane living skin equivalent is a cellular matrix that has been reportedly successful in treating paediatrics wounds and is currently under investigation in randomised clinical trials." }, { "field": "limitations", "quote": "high tier evidence in these populations is scarce" }, { "field": "limitations", "quote": "RCTs involving larger sample sizes are necessary" } ] }, { "id": "pmid:32507418", "pmid": "32507418", "doi": "10.1016/j.ctim.2020.102388", "nctId": null, "pmcid": null, "title": "HONEY DRESSING IN WOUND TREATMENT: A SYSTEMATIC REVIEW", "firstAuthor": "Yilmaz", "multipleAuthors": true, "journal": "Complement Ther Med", "year": 2020, "design": "systematic-review", "n": 30, "nField": "reported", "population": "people with acute and chronic wounds", "intervention": "honey dressing", "comparator": "other wound treatments (as reviewed in included trials)", "primaryOutcome": "wound healing outcomes", "result": "honey sped up healing, reduced inflammation, pain and infection, and was cost-effective", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it pools varied randomized trials without detailing their size or risk of bias, and does not separate manuka honey or anorectal surgery specifically.", "directness": "indirect", "limitations": "Abstract does not report study quality assessment, specific wound types, honey types, or anorectal surgery context.", "followUp": "", "plainFinding": "Faster wound healing with honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32507418/", "sourceText": "OBJECTIVE: The use of honey for wound treatment and care purposes is based on thousands of years of history. The development of science and in vitro/in vivo studies have demonstrated that honey contributes to wound healing by showing therapeutic effects by means of the bioactive compounds it contains. The aim of this systematic review was to evaluate the place of honey in wound treatment by investigating the randomized controlled studies. METHOD: 30 publications which were obtained as a result of the scans in the databases and which comply with the evaluation criteria were included in the review. RESULTS: In the results of the study, it was reported that honey in acute and chronic wounds provided rapid epithelization and wound contraction in wound healing, had anti-inflammatory and debridement effect, decreased the pain, ensured infection control, shortened the time of wound healing and was cost-effective.", "provenance": [ { "field": "population", "quote": "honey in acute and chronic wounds" }, { "field": "intervention", "quote": "The use of honey for wound treatment and care purposes" }, { "field": "comparator", "quote": "investigating the randomized controlled studies" }, { "field": "primaryOutcome", "quote": "evaluate the place of honey in wound treatment" }, { "field": "result", "quote": "provided rapid epithelization and wound contraction in wound healing, had anti-inflammatory and debridement effect, decreased the pain, ensured infection control, shortened the time of wound healing and was cost-effective" }, { "field": "n", "quote": "30 publications which were obtained as a result of the scans in the databases" } ] }, { "id": "pmid:32335523", "pmid": "32335523", "doi": null, "nctId": null, "pmcid": null, "title": "Micropore Particle Technology Promotes Wound Healing, Whereas Polyhexamethylene Biguanide Causes Tissue Degeneration: A Case Report", "firstAuthor": "Sams-Dodd", "multipleAuthors": true, "journal": "Wounds", "year": 2020, "design": "case-series", "n": null, "nField": "not-reported", "population": "a 72-year-old woman with a nontraumatic spinal cord injury and a large wound with underlying bone infection", "intervention": "Manuka honey applied to the wound", "comparator": "later treatments with micropore particle technology and then polyhexamethylene biguanide", "primaryOutcome": "whether the wound healed or worsened", "result": "the wound got worse during 5 weeks of Manuka honey treatment, then improved only after switching to a different dressing", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single patient case report with no control group, so it cannot show whether Manuka honey generally helps or harms wounds.", "directness": "indirect", "limitations": "single case, no comparison group, wound had multiple complex factors (spinal cord injury, osteomyelitis, abscess) that could explain the lack of healing besides the honey itself.", "followUp": "", "plainFinding": "Wound worsened despite honey treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32335523/", "sourceText": "CASE REPORT: A 72-year-old woman with a nontraumatic spinal cord injury developed eschar on her lower right back. An underlying abscess was identified, which upon surgical debridement left a large wound extending down to the hip bone. In addition, the hip suffered from chronic osteomyelitis and was exposed at the bottom of the wound. The wound was initially treated for 5 weeks with Manuka honey but deteriorated further. Next, micropore particle technology (MPPT) was used. It cleared the wound of necrotic tissue based on autolytic debridement and removed the soft tissue infection; over a 3-month period, the wound reduced 50% in volume. Treatment approach was changed to polyhexamethylene biguanide (PHMB) and was applied as a gel once every second day to the wound. After 6 days, it was observed to cause tissue degeneration, disruption of the structure of the exposed bone, and the appearance of froth coming through the hip bone. A pain syndrome developed and the use of PHMB was terminated on day 10. After a wash-out period, the use of MPPT was reinitiated. Over the following 8 months, MPPT continued to control the infectious debris coming from the hip bone and promote healing without affecting the bone or causing side effects. CONCLUSIONS: It is generally assumed that the cytotoxic properties of antiseptics seen in cell culture experiments do not occur on wounds. The present case shows these cytotoxic properties are expressed on wounds, and they do disrupt tissues and tissue regeneration.", "provenance": [ { "field": "n", "quote": "A 72-year-old woman with a nontraumatic spinal cord injury" }, { "field": "population", "quote": "A 72-year-old woman with a nontraumatic spinal cord injury developed eschar on her lower right back." }, { "field": "intervention", "quote": "The wound was initially treated for 5 weeks with Manuka honey but deteriorated further." }, { "field": "comparator", "quote": "Treatment approach was changed to polyhexamethylene biguanide (PHMB)" }, { "field": "primaryOutcome", "quote": "the wound reduced 50% in volume" }, { "field": "result", "quote": "The wound was initially treated for 5 weeks with Manuka honey but deteriorated further." } ] }, { "id": "pmid:32240741", "pmid": "32240741", "doi": "10.1016/j.ijbiomac.2020.03.237", "nctId": null, "pmcid": null, "title": "Manuka honey incorporated cellulose acetate nanofibrous mats: Fabrication and in vitro evaluation as a potential wound dressing", "firstAuthor": "Ullah", "multipleAuthors": true, "journal": "Int J Biol Macromol", "year": 2020, "design": "lab", "n": null, "nField": "not-reported", "population": "Laboratory testing with mouse fibroblast cells (NIH 3T3), not human patients", "intervention": "Manuka honey combined with cellulose acetate made into nanofiber wound dressing mats", "comparator": "Different amounts of manuka honey mixed into the cellulose acetate mats", "primaryOutcome": "Whether the manuka honey nanofiber mats fight bacteria, act as antioxidants, and are safe for cells in lab testing", "result": "The honey-infused mats stopped bacterial growth, showed antioxidant activity, and were safe for cells in lab dish testing", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is early lab material testing in cell dishes, not a study of real wounds or patients, so it cannot show whether this actually helps people heal.", "directness": "indirect", "limitations": "In vitro testing only; no animal or human wound healing data reported; no anorectal surgery population studied", "followUp": "", "plainFinding": "Lab material shows antibacterial, wound-healing potential", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32240741/", "sourceText": "Wound dressings are the primary barrier between the wound surface and the outer environment. Here we report the fabrication of cellulose acetate (CA)-Manuka honey (MH) composite nanofibrous mats as a biocompatible and antimicrobial wound dressing. CA mats with different quantities of MH were developed by electrospinning. The ATR-FTIR spectra confirm the inclusion of MH in the composite CA-MH nanofibrous mats. The fibers were continuous and bead-free with acceptable mechanical properties. The fiber diameter increased with an increase in MH content. Inclusion of MH in the electrospun composite CA-MH nanofibrous mats shows high efficacy to prevent bacterial growth on the wound surface. The MH loaded CA nanofiber mats showed good antioxidant abilities, while the ability to free radicalize the DPPH was dependent upon the factors of MH content in the fiber and the time of immersion in the DPPH solution. Besides, the nanofibrous mat's high porosity (85-90%) and WVTR values of 2600 to 1950 g/m2/day, suitable for wound breathability and the mats show high cytocompatibility to NIH 3T3 cell line in in vitro testing, proving to be effective for promoting wound healing.", "provenance": [ { "field": "intervention", "quote": "the fabrication of cellulose acetate (CA)-Manuka honey (MH) composite nanofibrous mats as a biocompatible and antimicrobial wound dressing" }, { "field": "comparator", "quote": "CA mats with different quantities of MH were developed by electrospinning" }, { "field": "primaryOutcome", "quote": "Inclusion of MH in the electrospun composite CA-MH nanofibrous mats shows high efficacy to prevent bacterial growth on the wound surface" }, { "field": "result", "quote": "The MH loaded CA nanofiber mats showed good antioxidant abilities" }, { "field": "result", "quote": "the mats show high cytocompatibility to NIH 3T3 cell line in in vitro testing, proving to be effective for promoting wound healing" }, { "field": "population", "quote": "the mats show high cytocompatibility to NIH 3T3 cell line in in vitro testing" } ] }, { "id": "pmid:32220630", "pmid": "32220630", "doi": "10.1016/j.ijid.2020.03.044", "nctId": null, "pmcid": null, "title": "The dilemma of diagnosing wound botulism in an infant: A rare case of paralysis with topical application of honey", "firstAuthor": "Mohd Tamrin", "multipleAuthors": false, "journal": "Int J Infect Dis", "year": 2020, "design": "case-series", "n": 1, "nField": "reported", "population": "an infant with an infected umbilical stump, which required a surgical wound debridement", "intervention": "application of topical medical grade honey for wound care", "comparator": "", "primaryOutcome": "developed a sudden progressive flaccid paralysis a few days after the application of topical medical grade honey for wound care", "result": "This infant developed a sudden progressive flaccid paralysis a few days after the application of topical medical grade honey for wound care. Even though suspicion of wound botulism is high, confirmation of the diagnosis, detection of neurotoxin, and isolating the organism remains a challenge.", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single case report, which cannot show whether honey usually helps or harms wounds, only that this one possible complication occurred.", "directness": "indirect", "limitations": "single case, diagnosis of wound botulism not confirmed by toxin detection or organism isolation, no comparison group", "followUp": "", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32220630/", "sourceText": "Botulism is a form of paralysis caused by a neurotoxin produced by the bacterium Clostridium botulinum. It is well known that natural honey contains Clostridium botulinum spores; controversy arises when a honey-related product is being used for wound care, where the possibility occurs of applying these spores to an open wound. To our knowledge, no reported cases of medical-grade honey have been associated with wound botulism. Given this fact, do we feel secure regarding the safety of this product, and will it be enough to alleviate our concern? We present a case of an infant with an infected umbilical stump, which required a surgical wound debridement. This infant developed a sudden progressive flaccid paralysis a few days after the application of topical medical grade honey for wound care. Even though suspicion of wound botulism is high, confirmation of the diagnosis, detection of neurotoxin, and isolating the organism remains a challenge.", "provenance": [ { "field": "population", "quote": "We present a case of an infant with an infected umbilical stump, which required a surgical wound debridement." }, { "field": "intervention", "quote": "application of topical medical grade honey for wound care" }, { "field": "primaryOutcome", "quote": "This infant developed a sudden progressive flaccid paralysis a few days after the application of topical medical grade honey for wound care." }, { "field": "result", "quote": "This infant developed a sudden progressive flaccid paralysis a few days after the application of topical medical grade honey for wound care. Even though suspicion of wound botulism is high, confirmation of the diagnosis, detection of neurotoxin, and isolating the organism remains a challenge." }, { "field": "n", "quote": "We present a case of an infant" } ] }, { "id": "pmid:31825770", "pmid": "31825770", "doi": "10.12968/jowc.2019.28.Sup12.S4", "nctId": null, "pmcid": null, "title": "Successful treatment of a diabetic foot ulcer with exposed bone using Trigona honey: a case study", "firstAuthor": "Astrada", "multipleAuthors": true, "journal": "J Wound Care", "year": 2019, "design": "case-series", "n": 1, "nField": "reported", "population": "a woman with a large infected diabetic foot ulcer with exposed bone", "intervention": "propolis-enriched Trigona honey dressing applied at home", "comparator": "none (single treatment, no comparison group)", "primaryOutcome": "wound healing (re-epithelialisation)", "result": "the wound fully healed over with new skin after two months", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report with no control group, so it cannot show whether honey caused the healing.", "directness": "indirect", "limitations": "only one patient, no comparison group, and the honey used (Trigona) is not manuka honey.", "followUp": "two months", "plainFinding": "Diabetic foot ulcer fully healed.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31825770/", "sourceText": "Many studies have shown that honey might improve wound healing. However, its efficacy for large wounds which may be followed by a systemic effect remains unclear. The effectiveness of honey-based dressings in treating large diabetic foot ulcers (DFU) is still unknown. This study presents the case of a 38-year-old female patient presenting with an extensive infected DFU with exposed bone. The DFU was treated with propolis-enriched Trigona honey, used as a single treatment, in a home visit setting. After two months' follow-up, the wound exhibited complete re-epithelialisation despite the patient's initial poor condition.", "provenance": [ { "field": "n", "quote": "a 38-year-old female patient" }, { "field": "population", "quote": "a 38-year-old female patient presenting with an extensive infected DFU with exposed bone" }, { "field": "intervention", "quote": "treated with propolis-enriched Trigona honey, used as a single treatment, in a home visit setting" }, { "field": "comparator", "quote": "used as a single treatment" }, { "field": "primaryOutcome", "quote": "the wound exhibited complete re-epithelialisation" }, { "field": "result", "quote": "After two months' follow-up, the wound exhibited complete re-epithelialisation despite the patient's initial poor condition." } ] }, { "id": "pmid:31804887", "pmid": "31804887", "doi": "10.12968/bjcn.2019.24.Sup12.S12", "nctId": null, "pmcid": null, "title": "A review of interventions to reduce pain in chronic wounds", "firstAuthor": "Snelgrove", "multipleAuthors": true, "journal": "Br J Community Nurs", "year": 2019, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with chronic wounds", "intervention": "honey dressing (among other wound care interventions)", "comparator": "other wound dressings and treatments reviewed in the literature", "primaryOutcome": "reduction of chronic wound pain", "result": "a honey dressing or native collagen matrix dressing and conditioning exercises for the lower leg can reduce pain, and nitroglycerin ointment is especially effective", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a general literature review without stated systematic methods or numbers of patients, so it cannot reliably show whether honey helps wounds heal.", "directness": "indirect", "limitations": "The abstract does not describe study designs, sample sizes, or specific methods used to select or assess the included studies, and it covers wound pain generally rather than manuka honey or anorectal surgery specifically.", "followUp": "", "plainFinding": "Honey dressing may reduce wound pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31804887/", "sourceText": "Reduction of chronic wound pain has the potential to improve patients' quality of life, expedite the healing process and, ultimately, relieve pressure on community services. Despite this, education on pain assessment in the management of chronic wounds is lacking. This literature review seeks to provide evidence-based recommendations to reduce chronic wound pain and inform the practice of community nurses. The results of a thematic analysis indicate that a honey dressing or native collagen matrix dressing and conditioning exercises for the lower leg can reduce pain, and nitroglycerin ointment is especially effective. The review also highlights the need for an individualised approach to the assessment and treatment of pain in patients with chronic wounds.", "provenance": [ { "field": "population", "quote": "patients with chronic wounds" }, { "field": "intervention", "quote": "a honey dressing or native collagen matrix dressing and conditioning exercises for the lower leg can reduce pain" }, { "field": "comparator", "quote": "nitroglycerin ointment is especially effective" }, { "field": "primaryOutcome", "quote": "Reduction of chronic wound pain has the potential to improve patients' quality of life" }, { "field": "result", "quote": "a honey dressing or native collagen matrix dressing and conditioning exercises for the lower leg can reduce pain, and nitroglycerin ointment is especially effective" } ] }, { "id": "pmid:31796774", "pmid": "31796774", "doi": "10.1038/s41598-019-54576-2", "nctId": null, "pmcid": "PMC6890799", "title": "Honey can inhibit and eliminate biofilms produced by Pseudomonas aeruginosa", "firstAuthor": "Lu", "multipleAuthors": true, "journal": "Sci Rep", "year": 2019, "design": "lab", "n": null, "nField": "not-reported", "population": "Pseudomonas aeruginosa bacteria grown in lab biofilms (not human patients)", "intervention": "New Zealand honey (including manuka honey) applied to bacterial biofilms", "comparator": "untreated biofilms / lower honey concentrations", "primaryOutcome": "ability of honey to prevent and kill bacterial biofilms", "result": "honey stopped biofilm formation, reduced established biofilms, and at clinical concentrations fully eliminated biofilms", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a lab dish experiment on bacteria, not a study of people with wounds, so it cannot show whether honey helps patients heal.", "directness": "indirect", "limitations": "abstract does not test honey on actual wounds or patients, only bacterial biofilms in the lab; does not address anorectal surgery", "followUp": "", "plainFinding": "Kills bacterial biofilms in lab tests", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31796774/", "sourceText": "Chronic wound treatment is becoming increasingly difficult and costly, further exacerbated when wounds become infected. Bacterial biofilms cause most chronic wound infections and are notoriously resistant to antibiotic treatments. The need for new approaches to combat polymicrobial biofilms in chronic wounds combined with the growing antimicrobial resistance crisis means that honey is being revisited as a treatment option due to its broad-spectrum antimicrobial activity and low propensity for bacterial resistance. We assessed four well-characterised New Zealand honeys, quantified for their key antibacterial components, methylglyoxal, hydrogen peroxide and sugar, for their capacity to prevent and eradicate biofilms produced by the common wound pathogen Pseudomonas aeruginosa. We demonstrate that: (1) honey used at substantially lower concentrations compared to those found in honey-based wound dressings inhibited P. aeruginosa biofilm formation and significantly reduced established biofilms; (2) the anti-biofilm effect of honey was largely driven by its sugar component; (3) cells recovered from biofilms treated with sub-inhibitory honey concentrations had slightly increased tolerance to honey; and (4) honey used at clinically obtainable concentrations completely eradicated established P. aeruginosa biofilms. These results, together with their broad antimicrobial spectrum, demonstrate that manuka honey-based wound dressings are a promising treatment for infected chronic wounds, including those with P. aeruginosa biofilms.", "provenance": [ { "field": "population", "quote": "Bacterial biofilms cause most chronic wound infections" }, { "field": "intervention", "quote": "We assessed four well-characterised New Zealand honeys" }, { "field": "comparator", "quote": "honey used at substantially lower concentrations compared to those found in honey-based wound dressings" }, { "field": "primaryOutcome", "quote": "their capacity to prevent and eradicate biofilms produced by the common wound pathogen Pseudomonas aeruginosa" }, { "field": "result", "quote": "honey used at clinically obtainable concentrations completely eradicated established P. aeruginosa biofilms" } ] }, { "id": "pmid:31759413", "pmid": "31759413", "doi": "10.1016/j.tice.2019.09.007", "nctId": null, "pmcid": null, "title": "Application of honey as a protective material in maintaining the viability of adipose stem cells in burn wound healing: A histological, molecular and biochemical study", "firstAuthor": "Oryan", "multipleAuthors": true, "journal": "Tissue Cell", "year": 2019, "design": "animal", "n": null, "nField": "not-reported", "population": "rats with burn wounds", "intervention": "honey combined with adipose stem cells (ASCs) under tegaderm dressing", "comparator": "other treatment regimes", "primaryOutcome": "wound healing measured by inflammation markers, angiogenesis, re-epithelialization, and granulation tissue formation", "result": "honey plus stem cell treatment improved angiogenesis, re-epithelialization, and granulation tissue formation compared to other treatments, with reduced inflammatory markers and increased growth factor expression", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is an animal study on burn wounds, not human anorectal surgery, with no participant numbers reported and no human applicability shown.", "directness": "indirect", "limitations": "Animal model only; no sample size reported; studies burn wounds not anorectal surgery; combines honey with stem cells rather than honey alone.", "followUp": "28 days", "plainFinding": "Better burn healing in rats.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31759413/", "sourceText": "Enhanced resistance to oxidative stress makes the adipose stem cells (ASCs) able to promote wound repair and regeneration. Such cells can be achieved by addition of an anti-oxidant to cell culture medium. In this study, a combination of honey (H) and ASCs was applied on burn wounds and the injured area was then covered by a tegaderm (T) dressing in a rat model. Wound healing was evaluated by histopathological, histomorphometrical, molecular, scanning electron microscopy, and biochemical assessments on days 7, 14, and 28 post-wounding. Treatment with ASCs-containing honey (T-H/ASC) resulted in substantial reduction in the level of pro-inflammatory cytokines including interleukin-1β (IL-1β) and transforming growth factor-β1 (TGF-β1) in wound bed, at 7 day post-surgery. T-H/ASCs also elevated the level of bFGF expression, indicating that ASCs enhanced angiogenesis, at 7 day post-wounding. T-H/ASCs significantly improved angiogenesis, re-epithelialization, and granulation tissue formation compared to other treatment regimes, at 14 day post-surgery. These outcomes were in exceptionally good agreement with the histological and biochemical findings. Increased bFGF level in the T-H/ASCs treated wounds at the 28th day post-surgery showed the anti-scarring activity of ASCs. Honey can be considered as a protective material in maintaining the viability of ASCs and improving the cellular resistance to oxidative stress. Furthermore, combination of ASCs and honey can provide a nutrient media for the ASCs and enhance the ability of regeneration of the ASC-based therapies.", "provenance": [ { "field": "population", "quote": "a combination of honey (H) and ASCs was applied on burn wounds and the injured area was then covered by a tegaderm (T) dressing in a rat model" }, { "field": "intervention", "quote": "Treatment with ASCs-containing honey (T-H/ASC)" }, { "field": "comparator", "quote": "compared to other treatment regimes" }, { "field": "primaryOutcome", "quote": "Wound healing was evaluated by histopathological, histomorphometrical, molecular, scanning electron microscopy, and biochemical assessments on days 7, 14, and 28 post-wounding." }, { "field": "result", "quote": "T-H/ASCs significantly improved angiogenesis, re-epithelialization, and granulation tissue formation compared to other treatment regimes, at 14 day post-surgery." } ] }, { "id": "pmid:31636855", "pmid": "31636855", "doi": "10.4317/jced.55743", "nctId": null, "pmcid": "PMC6797456", "title": "The influence of intra-alveolar application of honey versus Chlorhexidine rinse on the incidence of Alveolar Osteitis following molar teeth extraction. A randomized clinical parallel trial", "firstAuthor": "Abu-Mostafa", "multipleAuthors": true, "journal": "J Clin Exp Dent", "year": 2019, "design": "rct", "n": 100, "nField": "reported", "population": "adults having a single molar tooth pulled", "intervention": "Manuka honey placed directly into the tooth socket after extraction", "comparator": "chlorhexidine mouth rinse used twice daily for a week", "primaryOutcome": "development of dry socket (alveolar osteitis) after extraction", "result": "no significant difference in dry socket rates between honey and chlorhexidine, though honey group had slightly more pain, empty sockets, and dry socket cases", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "small trial with unequal group sizes and only one week of follow-up, so it can't reliably rule out a real difference", "directness": "indirect", "limitations": "unequal group sizes (43 vs 57), short follow-up of only 7 days, single trial", "followUp": "day 3 and day 7", "plainFinding": "No benefit over chlorhexidine rinse.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31636855/", "sourceText": "BACKGROUND: Alveolar Osteitis (AO) is a complication occurs on the post-extraction days that includes pain and disintegrated blood clot. Chlorhexidine (CHX) rinse after extraction is an effective method for decreasing the incidence of AO. Honey has natural antibacterial properties and effectiveness when it is used as a dressing on burns and wounds. However, the effect of intraoral honey dressings on healing is still not adequately studied. This study aimed to compare pain and AO after extraction of a molar tooth in a group of patients who received the intra-alveolar application of Manuka Honey post-operatively with another group who used 0.2% CHX rinse. MATERIAL AND METHODS: A randomized clinical trial of parallel groups was carried out on 100 patients who had a single molar tooth extraction. They were randomly divided into two groups. Group1 (G1) used 0.2 % CHX twice daily for 7 days. In Group2 (G2), Manuka Honey applied topically by a cotton swab into the socket directly after extraction and on Day3. Re-evaluation, including pain assessment, empty socket, and halitosis was done on day 3 and day 7. RESULTS: G1 included 43 patients and G2 included 57 patients. Higher grades of pain, more empty sockets, and halitosis were found in G2 than in G1 on day3 and day7 without significant differences. Four cases of AO were found in G1 (9.3%) and 7 cases in G2 (12.3%), without significant difference between the two groups according to Chi-squared tests (p=0.753). CONCLUSIONS: The application of Manuka honey in the extraction socket directly after extraction and on day 3 has been found to be insignificantly less efficient in the prevention of AO than CHX rinse twice daily for seven days. However, honey is promising as natural dressing material and further studies are recommended. Key words:Manuka honey, Chlorhexidine, Alveolar Osteitis, extraction, dry socket.", "provenance": [ { "field": "population", "quote": "100 patients who had a single molar tooth extraction" }, { "field": "intervention", "quote": "Manuka Honey applied topically by a cotton swab into the socket directly after extraction and on Day3" }, { "field": "comparator", "quote": "Group1 (G1) used 0.2 % CHX twice daily for 7 days" }, { "field": "primaryOutcome", "quote": "compare pain and AO after extraction of a molar tooth" }, { "field": "result", "quote": "Higher grades of pain, more empty sockets, and halitosis were found in G2 than in G1 on day3 and day7 without significant differences. Four cases of AO were found in G1 (9.3%) and 7 cases in G2 (12.3%), without significant difference between the two groups according to Chi-squared tests (p=0.753)." }, { "field": "n", "quote": "A randomized clinical trial of parallel groups was carried out on 100 patients who had a single molar tooth extraction." } ] }, { "id": "pmid:31607720", "pmid": "31607720", "doi": "10.4103/njcp.njcp_102_19", "nctId": null, "pmcid": null, "title": "Evaluation of the effect of honey on the healing of tooth extraction wounds in 4- to 9-year-old children", "firstAuthor": "Mokhtari", "multipleAuthors": true, "journal": "Niger J Clin Pract", "year": 2019, "design": "rct", "n": 51, "nField": "reported", "population": "children aged 4 to 9 years having a baby tooth pulled", "intervention": "honey applied to the tooth extraction wound", "comparator": "saline solution applied to the wound", "primaryOutcome": "size of the wound at day 3 and day 7 after extraction", "result": "wound sizes were significantly smaller in the honey group on both day 3 and day 7", "resultDirection": "benefit", "quality": "low", "qualityWhy": "small randomized trial in a different setting (children's tooth extractions, not anorectal surgery) measuring only wound size, so it gives limited confidence for other wound types.", "directness": "indirect", "limitations": "small sample size; outcome limited to wound size measurement; different honey type and surgical site than anorectal surgery", "followUp": "7 days", "plainFinding": "Faster healing of tooth sockets.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31607720/", "sourceText": "OBJECTIVE: The aim of the this study was to evaluate the effect of honey on the healing of tooth extraction wounds in children 4‒9 years of age. SUBJECTS AND METHODS: In the present randomized clinical trial, 51 patients, 4‒9 years of age were selected randomly. All the subjects required extraction of one deciduous molar tooth. The subjects were randomly assigned to two groups. In group 1, after extraction of the tooth, the dentist used a cotton swab applicator to place a layer of honey on a piece of gauze moistened with normal saline solution (NSS) and placed it on the socket. In group 2, honey was not used; rather, NSS was applied. On days 3 and 7 after tooth extraction, the wound sizes were measured. RESULTS: In both groups, the wound sizes decreased significantly on the third day compared with baseline and on the seventh day compared with the third day (P < 0.05). On the third and seventh days after tooth extraction, wound sizes in the honey group were significantly lower than those in the NSS group (P < 0.05). CONCLUSION: Honey resulted in a decrease in wound sizes and faster healing after extraction of teeth in children. Therefore, use of honey can be recommended after minor surgeries in the oral cavity.", "provenance": [ { "field": "population", "quote": "51 patients, 4‒9 years of age were selected randomly" }, { "field": "intervention", "quote": "the dentist used a cotton swab applicator to place a layer of honey on a piece of gauze moistened with normal saline solution (NSS) and placed it on the socket" }, { "field": "comparator", "quote": "In group 2, honey was not used; rather, NSS was applied" }, { "field": "primaryOutcome", "quote": "On days 3 and 7 after tooth extraction, the wound sizes were measured" }, { "field": "result", "quote": "On the third and seventh days after tooth extraction, wound sizes in the honey group were significantly lower than those in the NSS group (P < 0.05)" }, { "field": "n", "quote": "51 patients, 4‒9 years of age were selected randomly" } ] }, { "id": "pmid:33311037", "pmid": "33311037", "doi": null, "nctId": null, "pmcid": null, "title": "Effect of Honey on Healing Process of Extraction Socket in Rabbits", "firstAuthor": "Sarraf", "multipleAuthors": true, "journal": "Kathmandu Univ Med J (KUMJ)", "year": 2019, "design": "animal", "n": 6, "nField": "reported", "population": "rabbits with tooth extraction sockets", "intervention": "honey applied directly to the extraction site", "comparator": "normal saline applied to the extraction site", "primaryOutcome": "healing of the tooth socket, measured by fibroblast growth, new bone formation and inflammation", "result": "honey group had significantly more fibroblast proliferation and bony trabeculae formation than control, but no significant difference in inflammatory cells", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this was a tiny animal study of only six rabbits looking at tooth sockets, not human anorectal wounds, so it tells us little about people.", "directness": "indirect", "limitations": "small number of animals (six), animal model rather than humans, different wound type (dental extraction socket) than anorectal surgery, honey type not specified as manuka", "followUp": "7th day", "plainFinding": "Faster healing in rabbit tooth sockets.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33311037/", "sourceText": "Background Honey is regarded as the oldest wound dressing. It accelerates wound healing in burn, infected and open wounds. Its effect on wound healing process in extraction socket is not fully established till today. Objective To evaluate the effect of honey on the healing process of socket after tooth extraction in New Zealand White rabbits. Method Extraction of first premolar tooth on both sides of lower jaw in six rabbits was done under general anesthesia produced by ketamine and Xylazine followed by local application of honey on one socket (honey group) and normal saline (control group) in the opposite socket. On 7th day, biopsy was taken from the extraction site and histopathological examination was done. Student's t-test was used for comparison between the groups and the differences were considered to be statistically significant at P-value less than 0.05. Result There was a significant difference between control group and honey group in terms of fibroblast proliferation (p = 0.0019) and bony trabeculae formation (p=0.0003). Inflammatory cells were also observed in both groups and it was statistically not significant (p=1.0000). Overlying epithelium was hyperplastic in the both groups. Conclusion Local application of honey promoted the healing process by increasing fibroblast proliferation and bony trabeculae formation. Further studies in larger animals and human should be conducted to confirm the efficacy of honey in extraction socket healing.", "provenance": [ { "field": "population", "quote": "Extraction of first premolar tooth on both sides of lower jaw in six rabbits" }, { "field": "intervention", "quote": "local application of honey on one socket (honey group)" }, { "field": "comparator", "quote": "normal saline (control group) in the opposite socket" }, { "field": "primaryOutcome", "quote": "To evaluate the effect of honey on the healing process of socket after tooth extraction" }, { "field": "result", "quote": "There was a significant difference between control group and honey group in terms of fibroblast proliferation (p = 0.0019) and bony trabeculae formation (p=0.0003). Inflammatory cells were also observed in both groups and it was statistically not significant (p=1.0000)." }, { "field": "n", "quote": "six rabbits" }, { "field": "followUp", "quote": "On 7th day, biopsy was taken from the extraction site" } ] }, { "id": "pmid:31377541", "pmid": "31377541", "doi": "10.1016/j.ijscr.2019.07.009", "nctId": null, "pmcid": "PMC6677685", "title": "Benign tumours leading to total penile denudation treated with Manuka honey dressings: A case report and review of literature", "firstAuthor": "Sylvester-Hvid", "multipleAuthors": true, "journal": "Int J Surg Case Rep", "year": 2019, "design": "case-series", "n": 1, "nField": "reported", "population": "man with penile skin loss from tumours and infection", "intervention": "manuka honey dressings", "comparator": "failed skin graft surgery, no other comparator", "primaryOutcome": "wound healing and recovery of function", "result": "wound healed fully and sexual function returned", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report so it cannot show whether honey works in general", "directness": "indirect", "limitations": "only one patient, not anorectal surgery, no control group, treatment used as salvage after failed graft", "followUp": "", "plainFinding": "Penile wound healed with honey dressings.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31377541/", "sourceText": "INTRODUCTION: Penile denudation is a devastating condition often reconstructed with a split-thickness skin graft(STSG). As this kind of reconstruction is challenging, we present an non-invasive treatment using Manuka honey dressings with a satisfying result. This was performed as a salvage procedure after failed STSG. CASE: A 55-year-old non-smoking male was admitted from his general practitioner with a newly onset of phimosis and lower urinary tract symptoms. Benign tumours complicated with infection were found on all segments of the penis causing dehiscence of the skin. After surgical removal of tumours and an unsuccessful STSG, Manuka honey dressings was used. Full sexual function was regained, and the patient was satisfied with the result. DISCUSSION: Alternatives to STSG are full-thickness skin graft using the inguinal or scrotal borrowing method, or using a dermal matrix before a STSG. A rediscovered method is using Manuka honey, with its unique combination of bactericidal, anti-inflammatory and healing-promoting properties. A wide range of wound types may benefit from Manuka honey dressings. A recent Danish in vitro study on honey derived from various Danish floras even shows high antibacterial effect superior to commercial medical grade honey. Considering a growing resistance to antibiotics, medical honey may contribute as a alternative to extensive wound care. CONCLUSION: We successfully treated a penile denudation with Manuka honey following a failed STSG. Wounds, ulcers, and burns may be infected, and can be challenging, time consuming, and expensive to treat. Manuka honey may be a good alternative to reconstructive surgery and can be managed on an out-patient basis.", "provenance": [ { "field": "n", "quote": "A 55-year-old non-smoking male" }, { "field": "population", "quote": "Penile denudation is a devastating condition" }, { "field": "intervention", "quote": "Manuka honey dressings was used" }, { "field": "comparator", "quote": "after failed STSG" }, { "field": "primaryOutcome", "quote": "Full sexual function was regained, and the patient was satisfied with the result." }, { "field": "result", "quote": "We successfully treated a penile denudation with Manuka honey following a failed STSG." } ] }, { "id": "pmid:31276452", "pmid": "31276452", "doi": "10.1097/WON.0000000000000541", "nctId": null, "pmcid": null, "title": "Topical Leptospermum Honey in the Management of Aplasia Cutis Congenita in Neonates: A Case Study", "firstAuthor": "Boyar", "multipleAuthors": false, "journal": "J Wound Ostomy Continence Nurs", "year": 2019, "design": "case-series", "n": 1, "nField": "reported", "population": "a newborn baby with a large area of missing skin at birth (aplasia cutis congenita)", "intervention": "topical Leptospermum (manuka) honey applied twice daily under a dressing", "comparator": "no control group; compared with previously published healing times", "primaryOutcome": "complete closure of the skin defect", "result": "The wound fully closed, with healing time similar to or faster than reported in other studies", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single case report with no comparison group, so it cannot show whether honey caused the improvement.", "directness": "indirect", "limitations": "Only one patient, no control group, and a very different wound type (congenital skin defect) from anorectal surgical wounds.", "followUp": "", "plainFinding": "Wound closed fully with honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31276452/", "sourceText": "BACKGROUND: Aplasia cutis congenita (ACC) is an uncommon, heterogeneous group of disorders characterized by focal or widespread absence of skin from certain parts of the body. Complications range from 20% to 50%; they are potentially life-threatening. There is no consensus on best treatment of ACC. We report on successful closure of aplasia cutis lesions using topical active Leptospermum honey (ALH). CASES: This article describes a case of a full-term neonate with a large ACC lesion. A conservative approach was taken in the care of this lesion, in accordance with appropriate wound care principles and the care of this medically fragile neonate. This included applying topical ALH twice a day and covering defects with a secure dressing. All lesions progressed to complete closure. Time to closure was either similar or shorter than published data. CONCLUSIONS: Our experience with these cases suggests that topical ALH may be an effective natural treatment option for neonates with ACC. This conservative management led to wound closure without topical or systemic antibiotics or prolonged hospital stay.", "provenance": [ { "field": "population", "quote": "a case of a full-term neonate with a large ACC lesion" }, { "field": "intervention", "quote": "applying topical ALH twice a day and covering defects with a secure dressing" }, { "field": "comparator", "quote": "Time to closure was either similar or shorter than published data." }, { "field": "primaryOutcome", "quote": "All lesions progressed to complete closure." }, { "field": "result", "quote": "All lesions progressed to complete closure. Time to closure was either similar or shorter than published data." }, { "field": "n", "quote": "a case of a full-term neonate with a large ACC lesion" } ] }, { "id": "pmid:31242111", "pmid": "31242111", "doi": "10.12968/bjon.2019.28.12.S23", "nctId": null, "pmcid": null, "title": "Medicinal honey in clinical practice: viable alternative or useful adjunct in wound care management?", "firstAuthor": "Shan", "multipleAuthors": false, "journal": "Br J Nurs", "year": 2019, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with wounds", "intervention": "medicinal honey, especially manuka honey", "comparator": "", "primaryOutcome": "wound healing and antimicrobial effect", "result": "no large-scale trials yet, but case studies suggest benefits for wound healing", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a narrative review based on in vitro studies and case reports, not controlled trials, so it can't reliably show whether honey works", "directness": "indirect", "limitations": "abstract states large-scale clinical trials are yet to be conducted and evidence is from in vitro studies and case studies", "followUp": "", "plainFinding": "No strong evidence yet.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31242111/", "sourceText": "In light of concerns raised about antimicrobial resistance, especially in hospitals, and the rise in bacteria that are resistant to antibiotics scientists are examining alternative sources and strategies to combat infection. Among the plethora of complementary medicines now being considered is honey, particularly manuka honey. Medicinal honey is a relatively new label given to some types of honey that have been shown to be effective antimicrobial agents in in vitro studies. Large-scale clinical trials are yet to be conducted but there is considerable interest and numerous case studies that demonstrate the benefits of medicinal honey, especially in wound healing.", "provenance": [ { "field": "intervention", "quote": "Among the plethora of complementary medicines now being considered is honey, particularly manuka honey." }, { "field": "population", "quote": "especially in wound healing" }, { "field": "primaryOutcome", "quote": "effective antimicrobial agents in in vitro studies" }, { "field": "result", "quote": "Large-scale clinical trials are yet to be conducted but there is considerable interest and numerous case studies that demonstrate the benefits of medicinal honey, especially in wound healing." } ] }, { "id": "pmid:31151507", "pmid": "31151507", "doi": "10.1016/j.carbpol.2019.05.004", "nctId": null, "pmcid": null, "title": "Honey loaded alginate/PVA nanofibrous membrane as potential bioactive wound dressing", "firstAuthor": "Tang", "multipleAuthors": true, "journal": "Carbohydr Polym", "year": 2019, "design": "lab", "n": null, "nField": "not-reported", "population": "laboratory testing of a wound dressing material, not human patients", "intervention": "honey incorporated into an alginate/PVA electrospun nanofiber membrane", "comparator": "nanofibrous membranes with varying honey content (compared to each other/no honey)", "primaryOutcome": "antioxidant activity, antibacterial activity, and cytotoxicity of the honey-loaded nanofiber membrane", "result": "Honey-loaded membranes showed enhanced antioxidant activity, antibacterial activity against S. aureus and E. coli, and were non-cytotoxic and biocompatible", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a laboratory material-science study testing the dressing's chemical and antibacterial properties, not a clinical trial on actual wounds or patients.", "directness": "indirect", "limitations": "Purely in-vitro/lab characterization study; no animal or human wound healing data reported.", "followUp": "", "plainFinding": "Promising honey dressing material in lab tests.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31151507/", "sourceText": "Honey is an ancient natural wound-healing agent and has been reintroduced to modern clinical wound care as it has various bioactivities. In this study, honey was incorporated into an alginate/PVA-based electrospun nanofibrous membrane to develop an efficient wound dressing material. The morphology and chemical composition of the nanofibrous membrane were observed by scanning electron microscopy and characterized via Fourier transform infrared spectroscopy, respectively, demonstrating that honey was successfully introduced to the nanofibers. The nanofibrous membranes with increasing honey content showed enhanced antioxidant activity, suggesting the ability to control the overproduction of reactive oxygen species. Disc diffusion assay and dynamic contact assay proved the antibacterial activity of the honey loaded nanofibers towards Gram-positive bacterium (Staphylococcus aureus) and Gram-negative bacterium (Escherichia coli). The cytotoxicity assay illustrated the non-cytotoxicity and biocompatibility of the nanofibrous membranes. Therefore, the developed honey/alginate/PVA nanofibrous membranes are promising for wound dressings.", "provenance": [ { "field": "intervention", "quote": "honey was incorporated into an alginate/PVA-based electrospun nanofibrous membrane to develop an efficient wound dressing material" }, { "field": "comparator", "quote": "The nanofibrous membranes with increasing honey content showed enhanced antioxidant activity" }, { "field": "primaryOutcome", "quote": "demonstrating that honey was successfully introduced to the nanofibers" }, { "field": "result", "quote": "The nanofibrous membranes with increasing honey content showed enhanced antioxidant activity, suggesting the ability to control the overproduction of reactive oxygen species. Disc diffusion assay and dynamic contact assay proved the antibacterial activity of the honey loaded nanofibers towards Gram-positive bacterium (Staphylococcus aureus) and Gram-negative bacterium (Escherichia coli). The cytotoxicity assay illustrated the non-cytotoxicity and biocompatibility of the nanofibrous membranes." }, { "field": "population", "quote": "Disc diffusion assay and dynamic contact assay proved the antibacterial activity of the honey loaded nanofibers towards Gram-positive bacterium (Staphylococcus aureus) and Gram-negative bacterium (Escherichia coli)." } ] }, { "id": "pmid:31003516", "pmid": "31003516", "doi": "10.3390/gels5020021", "nctId": null, "pmcid": "PMC6631429", "title": "Investigating Manuka Honey Antibacterial Properties When Incorporated into Cryogel, Hydrogel, and Electrospun Tissue Engineering Scaffolds", "firstAuthor": "Hixon", "multipleAuthors": true, "journal": "Gels", "year": 2019, "design": "lab", "n": null, "nField": "not-reported", "population": "Lab experiment testing scaffolds with bacteria and cells, not patients or wounds", "intervention": "Manuka honey incorporated into cryogel, hydrogel, or electrospun tissue scaffolds", "comparator": "Different scaffold geometries compared to each other", "primaryOutcome": "Bacterial clearance, bacterial adhesion, and cellular adhesion in lab testing", "result": "Electrospun scaffolds released Manuka honey faster and cleared more bacteria, while cryogels and hydrogels released it slower for longer-term effect", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "This is a laboratory materials experiment with no patients or wounds, so it cannot show whether honey helps wounds heal in people.", "directness": "indirect", "limitations": "Abstract does not report sample sizes or statistical testing, and this is an in-vitro study not involving human wounds or surgery.", "followUp": "", "plainFinding": "Lab test of honey-infused scaffolds, not healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31003516/", "sourceText": "Honey is well-known for its wound healing capability and Manuka honey (MH) contains a unique Manuka factor, providing an additional antibacterial agent. Previously, there has not been a practical way to apply MH to a wound site, which renders treatment for an extended period extremely difficult. Tissue-engineered scaffolds offer an alternative treatment method to standard dressings by providing varying geometries to best treat the specific tissue. MH was incorporated into cryogels, hydrogels, and electrospun scaffolds to assess the effect of scaffold geometry on bacterial clearance and adhesion, as well as cellular adhesion. Electrospun scaffolds exhibited a faster release due to the nanoporous fibrous geometry which led to a larger partial bacterial clearance as compared to the more three-dimensional cryogels (CG) and hydrogels (HG). Similarly, the fast release of MH from the electrospun scaffolds resulted in reduced bacterial adhesion. Overall, the fast MH release of the electrospun scaffolds versus the extended release of the HG and CG scaffolds provides differences in cellular/bacterial adhesion and advantages for both short and long-term applications, respectively. This manuscript provides a comparison of the scaffold pore structures as well as bacterial and cellular properties, providing information regarding the relationship between varying scaffold geometry and MH efficacy.", "provenance": [ { "field": "population", "quote": "MH was incorporated into cryogels, hydrogels, and electrospun scaffolds to assess the effect of scaffold geometry on bacterial clearance and adhesion, as well as cellular adhesion." }, { "field": "intervention", "quote": "MH was incorporated into cryogels, hydrogels, and electrospun scaffolds" }, { "field": "comparator", "quote": "Overall, the fast MH release of the electrospun scaffolds versus the extended release of the HG and CG scaffolds provides differences in cellular/bacterial adhesion" }, { "field": "primaryOutcome", "quote": "to assess the effect of scaffold geometry on bacterial clearance and adhesion, as well as cellular adhesion" }, { "field": "result", "quote": "Electrospun scaffolds exhibited a faster release due to the nanoporous fibrous geometry which led to a larger partial bacterial clearance as compared to the more three-dimensional cryogels (CG) and hydrogels (HG)." } ] }, { "id": "pmid:31000336", "pmid": "31000336", "doi": "10.1016/j.jtv.2019.04.002", "nctId": null, "pmcid": null, "title": "Applying honey dressings to non-healing wounds in elderly persons receiving home care", "firstAuthor": "Zeleníková", "multipleAuthors": true, "journal": "J Tissue Viability", "year": 2019, "design": "rct", "n": 40, "nField": "reported", "population": "elderly home care patients over 65 with non-healing wounds", "intervention": "honey dressings", "comparator": "conventional wound dressings", "primaryOutcome": "wound healing (size, complete healing) and pain intensity over 3 months", "result": "80% of honey-treated wounds fully healed vs 30% of controls, with significantly smaller wound size and less pain in the honey group after 90 days", "resultDirection": "benefit", "quality": "low", "qualityWhy": "small study of only 40 people with no mention of blinding, so results could be due to chance or bias.", "directness": "indirect", "limitations": "Small sample size; no mention of blinding; honey type not specified as manuka; population is general non-healing wounds in elderly home care, not anorectal surgery patients.", "followUp": "three months", "plainFinding": "Faster healing, less pain with honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31000336/", "sourceText": "OBJECTIVE: The study aimed to determine the clinical effectiveness of honey dressings in the management of non-healing wounds in elderly persons receiving home care. MATERIAL AND METHODS: Design: a prospective interventional study. The sample comprised 40 Czech home care clients (aged over 65 years) with non-healing wounds who were randomly assigned to two groups. Wounds were treated with honey (intervention group) or conventional (controls) dressings. Each wound was studied for three months. A detailed description of a wound (location, size, wound bed, edges, amount of exudate, odor, adjacent skin) were recorded. Wounds were assessed with the Wound Healing Continuum and pain intensity with the Visual Analog Scale. RESULTS: Over the 3-month period, 16 (80%) individuals in the intervention group had their wounds completely healed, as compared with only six (30%) controls. There was no statistically significant difference in wound size between the groups on Day 1 (p = 0.1801). Ninety days later, the difference in wound size between the groups was statistically significant (p = 0.0041). There was a statistically significant difference in pain intensity between the two groups (p = 0.0007), with higher pain scores being indicated by controls. CONCLUSION: The study results showed that the application of honey dressings to non-healing wounds resulted in faster healing, wound size reduction and lower pain intensity.", "provenance": [ { "field": "n", "quote": "The sample comprised 40 Czech home care clients" }, { "field": "population", "quote": "elderly persons receiving home care" }, { "field": "intervention", "quote": "Wounds were treated with honey (intervention group)" }, { "field": "comparator", "quote": "conventional (controls) dressings" }, { "field": "primaryOutcome", "quote": "Wounds were assessed with the Wound Healing Continuum and pain intensity with the Visual Analog Scale" }, { "field": "result", "quote": "16 (80%) individuals in the intervention group had their wounds completely healed, as compared with only six (30%) controls" }, { "field": "result", "quote": "the difference in wound size between the groups was statistically significant (p = 0.0041)" }, { "field": "result", "quote": "higher pain scores being indicated by controls" } ] }, { "id": "pmid:30925246", "pmid": "30925246", "doi": "10.12968/bjon.2019.28.6.S30", "nctId": null, "pmcid": null, "title": "Properties and use of a honey dressing and gel in wound management", "firstAuthor": "Henry", "multipleAuthors": true, "journal": "Br J Nurs", "year": 2019, "design": "case-series", "n": 4, "nField": "reported", "population": "patients with various types of wounds", "intervention": "a medical-grade honey dressing and gel (Revamil)", "comparator": "no comparator reported", "primaryOutcome": "wound management outcomes such as healing, infection and debridement", "result": "the abstract describes case studies illustrating the dressing's attributes without giving a quantified outcome", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small set of four case reports with no control group, so it cannot show whether honey caused any improvement.", "directness": "indirect", "limitations": "No comparator group, only four case studies, and the honey type is not manuka-specific nor related to anorectal surgery.", "followUp": "", "plainFinding": "Case reports only, no proof shown.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30925246/", "sourceText": "Wound management is a major clinical challenge and puts a significant financial burden on the NHS. Because of the rise in long-term conditions including diabetes, obesity and an ageing population, practitioners regularly encounter a wide variety of wound types. In recent years, there has been a resurgence of interest in the use of medical-grade honey in the management of wounds. Honey is anti-inflammatory in action and has the capability to treat local infection, promote autolytic debridement, deodorise wounds and promote granulation tissue. Revamil is a recent addition to the range of honey dressings available and is intended to manage the majority of problems that may arise during wound care episodes. The attributes of Revamil will be illustrated through four case studies.", "provenance": [ { "field": "n", "quote": "four case studies" }, { "field": "population", "quote": "practitioners regularly encounter a wide variety of wound types" }, { "field": "intervention", "quote": "Revamil is a recent addition to the range of honey dressings available" }, { "field": "comparator", "quote": "The attributes of Revamil will be illustrated through four case studies." }, { "field": "primaryOutcome", "quote": "promote autolytic debridement, deodorise wounds and promote granulation tissue" }, { "field": "result", "quote": "The attributes of Revamil will be illustrated through four case studies." } ] }, { "id": "pmid:30728706", "pmid": "30728706", "doi": "10.1007/s12663-018-1142-z", "nctId": null, "pmcid": "PMC6328820", "title": "Effect of Intrasocket Application of Manuka Honey on Postsurgical Pain of Impacted Mandibular Third Molars Surgery: Split-Mouth Randomized Controlled Trial", "firstAuthor": "Al-Khanati", "multipleAuthors": true, "journal": "J Maxillofac Oral Surg", "year": 2019, "design": "rct", "n": 33, "nField": "reported", "population": "patients having impacted lower wisdom teeth removed on both sides", "intervention": "Manuka honey placed in the tooth socket before stitching", "comparator": "no honey applied (nothing placed in the socket)", "primaryOutcome": "pain intensity after surgery measured on a visual pain scale", "result": "pain scores were lower with honey on the first and second days after surgery, and patients needed less pain medicine", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it is a small randomized study of only 33 people measuring pain for a few days, which is a different situation from wound healing after anorectal surgery", "directness": "indirect", "limitations": "Abstract does not describe blinding of pain assessment, and the surgery and body site are very different from anorectal wounds.", "followUp": "7 days", "plainFinding": "Less pain after tooth extraction.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30728706/", "sourceText": "BACKGROUND AND PURPOSE: Sufficient evidence exists recommending the use of honey in the management of wounds. Studies revealed that the healing effect of honey could be classified by its antibacterial and anti-inflammatory properties of its components. Since surgical extraction of impacted molars is one of the most common operations in the oral cavity and the postoperative pain disturbing the patient may reduce the quality of health service, this study aimed to assess the analgesic potential of Manuka honey application into the extraction socket of impacted mandibular third molars. METHODS: This randomized split-mouth controlled study included 33 patients undergoing impacted bilateral lower third molars surgery under local anesthesia (n = 66). Randomization was carried out by coin flipping. One of the two impacted third molars was assigned to treatment group (Manuka honey applied just before suturing), other side to control group (nothing applied). Postsurgical pain was evaluated using visual analogue scale (VAS) of faces 7 days after extraction. The total analgesic dose used was also evaluated. RESULTS: In treatment group, postoperative VAS scores were significantly lower compared to that in control group regarding first and second days postoperatively (P < 0.05). Total analgesic intake in the control group was significantly higher (P = 0.0001). CONCLUSION: This study demonstrated that intrasocket application of Manuka honey after surgical extraction of impacted lower third molar is an effective method for reducing acute postsurgical pain.", "provenance": [ { "field": "population", "quote": "patients undergoing impacted bilateral lower third molars surgery under local anesthesia" }, { "field": "n", "quote": "This randomized split-mouth controlled study included 33 patients" }, { "field": "intervention", "quote": "Manuka honey applied just before suturing" }, { "field": "comparator", "quote": "other side to control group (nothing applied)" }, { "field": "primaryOutcome", "quote": "Postsurgical pain was evaluated using visual analogue scale (VAS) of faces 7 days after extraction" }, { "field": "result", "quote": "postoperative VAS scores were significantly lower compared to that in control group regarding first and second days postoperatively (P < 0.05). Total analgesic intake in the control group was significantly higher (P = 0.0001)." } ] }, { "id": "pmid:30712715", "pmid": "30712715", "doi": "10.1016/j.ctcp.2018.09.004", "nctId": null, "pmcid": null, "title": "Effectiveness of honey dressing in the treatment of diabetic foot ulcers: A systematic review and meta-analysis", "firstAuthor": "Wang", "multipleAuthors": true, "journal": "Complement Ther Clin Pract", "year": 2019, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people with diabetic foot ulcers", "intervention": "honey dressing applied to the wound", "comparator": "other wound dressings", "primaryOutcome": "wound debridement time, wound healing time, bacterial clearance time and rates", "result": "honey dressing shortened debridement, healing and bacterial clearance times and increased healing and bacterial clearance rates in the first one to two weeks", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it pools randomized and non-randomized studies without reporting participant numbers or study quality details, so the strength of the evidence is hard to judge.", "directness": "indirect", "limitations": "abstract does not specify number of studies or participants, types of honey used, or risk of bias; studies were a mix of RCTs and quasi-experimental designs.", "followUp": "", "plainFinding": "Faster healing of diabetic foot ulcers.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30712715/", "sourceText": "OBJECTIVE: Honey dressing has been applied in the treatment of diabetic foot ulcers (DFUs). However, there is a lack of research showing ample evidence that honey dressing is more effective in the treatment of DFUs than other dressings. This study aimed to examine the effects of honey dressing on wound-healing process for DFUs. METHOD: We searched for evidence regarding honey dressing used in the treatment of DFUs in various databases. We selected randomized controlled trials (RCTs) and quasi-experimental studies for meta-analysis. RESULTS: The meta-analysis showed that honey dressing effectively shortened the wound debridement time, wound healing time, and bacterial clearance time; it increased the wound healing rate and bacterial clearance rate during the first one to two weeks of use. CONCLUSION: Our findings suggest that honey dressing effectively promotes healing in DFUs. Further research is needed to elucidate these findings so that this form of treatment can be widely applied.", "provenance": [ { "field": "population", "quote": "treatment of diabetic foot ulcers (DFUs)" }, { "field": "intervention", "quote": "Honey dressing has been applied in the treatment of diabetic foot ulcers (DFUs)" }, { "field": "comparator", "quote": "honey dressing is more effective in the treatment of DFUs than other dressings" }, { "field": "primaryOutcome", "quote": "shortened the wound debridement time, wound healing time, and bacterial clearance time" }, { "field": "result", "quote": "it increased the wound healing rate and bacterial clearance rate during the first one to two weeks of use" } ] }, { "id": "pmid:30694209", "pmid": "30694209", "doi": null, "nctId": null, "pmcid": null, "title": "Medical-grade Honey as an Alternative to Surgery: A Case Series", "firstAuthor": "Bayron", "multipleAuthors": true, "journal": "Wounds", "year": 2019, "design": "case-series", "n": 12, "nField": "reported", "population": "patients with complex wounds who declined surgery", "intervention": "medical-grade Leptospermum (manuka) honey applied to wounds", "comparator": "no comparator (alternative to surgical debridement or skin grafting)", "primaryOutcome": "wound healing without surgery", "result": "all 12 patients healed or improved using honey instead of surgery, without hospital readmission", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a small uncontrolled case series with no comparison group, so it cannot reliably show the honey caused the improvement", "directness": "indirect", "limitations": "no control group, small number of patients, selected from clinical experience and chart review rather than a controlled trial", "followUp": "", "plainFinding": "Wounds healed without surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30694209/", "sourceText": "INTRODUCTION: Modern wound management continues to present new challenges. Many patients elect to forego operative debridement secondary to high risk, fear, cost concerns, and personal ideologies on healing. Although operative debridement has long been a tenet of proper wound care, alternative innovative approaches to wound management must be considered. OBJECTIVE: This case series describes the successful outcomes of 12 patients with dissimilar wounds who were managed with medical-grade honey (active Leptospermum honey [ALH]) as an alternative to surgery. MATERIALS AND METHODS: A case series was identified from clinical experience, chart review, and photographic documentation of all patients evaluated by the acute wound care service. To be included, patients had to decline the recommendation of operative debridement or skin grafting, utilize ALH as an alternative to surgery, and have regular follow-up visits. RESULTS: Twelve patients with complex wounds were identified and included in this case series. Five patients were considered high risk for surgery due to comorbidities. Seven patients were at low risk for surgery but desired to avoid operative procedures. The use of ALH facilitated autolytic debridement and healing without surgery or hospital readmission. CONCLUSIONS: The properties of ALH include autolytic debridement, bacterial growth inhibition, anti-inflammatory mediation, and cytokine release, making it a viable option for wound management for patients with contraindications to surgery. However, surgical debridement should remain a tenet of wound care in appropriate patients.", "provenance": [ { "field": "n", "quote": "Twelve patients with complex wounds were identified and included in this case series." }, { "field": "population", "quote": "patients had to decline the recommendation of operative debridement or skin grafting" }, { "field": "intervention", "quote": "medical-grade honey (active Leptospermum honey [ALH]) as an alternative to surgery" }, { "field": "comparator", "quote": "as an alternative to surgery" }, { "field": "primaryOutcome", "quote": "facilitated autolytic debridement and healing without surgery or hospital readmission" }, { "field": "result", "quote": "The use of ALH facilitated autolytic debridement and healing without surgery or hospital readmission." } ] }, { "id": "pmid:30252823", "pmid": "30252823", "doi": "10.1097/PRS.0000000000004799", "nctId": null, "pmcid": null, "title": "Treatment of Infected Wounds in the Age of Antimicrobial Resistance: Contemporary Alternative Therapeutic Options", "firstAuthor": "Karinja", "multipleAuthors": true, "journal": "Plast Reconstr Surg", "year": 2018, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with infected wounds, in context of rising antibiotic resistance", "intervention": "alternative non-antibiotic wound therapies, including honey", "comparator": "", "primaryOutcome": "", "result": "the abstract lists honey as one of several promising alternative therapies but does not report any specific outcome or data for it", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a narrative review describing a category of treatments without reporting specific study results, patient numbers, or outcomes for honey.", "directness": "indirect", "limitations": "abstract does not describe methodology, does not focus specifically on manuka honey or anorectal surgery, and reports no concrete findings for honey", "followUp": "", "plainFinding": "No specific results reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30252823/", "sourceText": "As antibiotic resistance increases and antimicrobial options diminish, there is a pressing need to identify and develop new and/or alternative (non-antimicrobial-based) wound therapies. The authors describe the implications of antibiotic resistance on their current wound treatment paradigms and review the most promising non-antibiotic-based antimicrobial agents currently in research and development, with a focus on preclinical and human studies of therapeutic bacteriophages, antimicrobial peptides, cold plasma treatment, photodynamic therapy, honey, silver, and bioelectric dressings.", "provenance": [ { "field": "intervention", "quote": "with a focus on preclinical and human studies of therapeutic bacteriophages, antimicrobial peptides, cold plasma treatment, photodynamic therapy, honey, silver, and bioelectric dressings" }, { "field": "population", "quote": "As antibiotic resistance increases and antimicrobial options diminish, there is a pressing need to identify and develop new and/or alternative (non-antimicrobial-based) wound therapies" }, { "field": "result", "quote": "review the most promising non-antibiotic-based antimicrobial agents currently in research and development" } ] }, { "id": "pmid:30248422", "pmid": "30248422", "doi": "10.1016/j.ijbiomac.2018.09.124", "nctId": null, "pmcid": null, "title": "Scar free healing mediated by the release of aloe vera and manuka honey from dextran bionanocomposite wound dressings", "firstAuthor": "Singh", "multipleAuthors": true, "journal": "Int J Biol Macromol", "year": 2018, "design": "animal", "n": null, "nField": "not-reported", "population": "Mice with experimentally created wounds", "intervention": "Wound dressing made from a dextran-based nanocomposite material containing aloe vera and manuka honey", "comparator": "Not clearly reported — base dressing material without aloe vera/manuka honey is implied but not explicitly compared for healing", "primaryOutcome": "Wound healing, scar prevention and skin appearance after treatment", "result": "Mice treated with the aloe-vera-loaded dressing showed better skin healing (new skin growth) and complete wound closure by day 14, with orderly collagen formation and a thin top skin layer; the dressings also killed over 99% of two types of bacteria in lab tests", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a small lab/animal study with no reported sample size, no statistics, and the healing benefit described is specifically credited to aloe vera rather than clearly isolating manuka honey's effect.", "directness": "indirect", "limitations": "Animal (mouse) model only, no human data; sample size not reported; the healing result highlighted is for the aloe-vera dressing, not clearly separated from the manuka honey dressing's effect; no statistical comparison reported.", "followUp": "14th post wounding day", "plainFinding": "Faster, scar-free healing in mice (lab study).", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30248422/", "sourceText": "Scar preventive dextran based bionanocomposite dressings containing aloe vera (AV) and manuka honey (MH) were developed as wound care devices. This work was a challenge to fabricate herbal dressing that promotes healing, which at the same time is biocompatible, non-toxic, biodegradable, and cost effective in terms of the simplicity of application in complex chronic wound situations. With this aim, we synthesized in-situ crosslinked dextran/nanosoy/glycerol/chitosan (DNG/Ch) nanocomposite membranes via solvent casting technique followed by subsequent addition of AV and MH to obtain DNG/Ch/AV and DNG/Ch/MH herbal dressings. The drug release kinetics of the bionanocomposite dressings indicated an initial burst release of AV and MH, followed by controlled release when examined in-vitro using non-fickian and quasi-fickian model. Antibacterial studies confirmed >99% antibacterial activity against both Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) and bacterial adherence test demonstrated its efficacy for arresting microbial invasion. Wound healing analysis conducted in-vivo showed enhanced epithelialization in the terms scar prevention and aesthetics with absolute wound contraction for the mice treated with AV loaded dressings after 14th post wounding day. Histological features displayed ordered deposition of collagen with a thin epidermis layer. Hence, the present herbal dressing could function without many cytotoxicity and biocompatibility issues.", "provenance": [ { "field": "population", "quote": "Wound healing analysis conducted in-vivo showed enhanced epithelialization in the terms scar prevention and aesthetics with absolute wound contraction for the mice treated with AV loaded dressings after 14th post wounding day." }, { "field": "intervention", "quote": "we synthesized in-situ crosslinked dextran/nanosoy/glycerol/chitosan (DNG/Ch) nanocomposite membranes via solvent casting technique followed by subsequent addition of AV and MH to obtain DNG/Ch/AV and DNG/Ch/MH herbal dressings." }, { "field": "comparator", "quote": "we synthesized in-situ crosslinked dextran/nanosoy/glycerol/chitosan (DNG/Ch) nanocomposite membranes via solvent casting technique followed by subsequent addition of AV and MH to obtain DNG/Ch/AV and DNG/Ch/MH herbal dressings." }, { "field": "primaryOutcome", "quote": "Wound healing analysis conducted in-vivo showed enhanced epithelialization in the terms scar prevention and aesthetics with absolute wound contraction for the mice treated with AV loaded dressings after 14th post wounding day." }, { "field": "result", "quote": "Wound healing analysis conducted in-vivo showed enhanced epithelialization in the terms scar prevention and aesthetics with absolute wound contraction for the mice treated with AV loaded dressings after 14th post wounding day." }, { "field": "result", "quote": "Antibacterial studies confirmed >99% antibacterial activity against both Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli)" } ] }, { "id": "pmid:30231567", "pmid": "30231567", "doi": "10.3390/molecules23092392", "nctId": null, "pmcid": "PMC6225154", "title": "Treatment Strategies for Infected Wounds", "firstAuthor": "Negut", "multipleAuthors": true, "journal": "Molecules", "year": 2018, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with infected skin wounds", "intervention": "wound dressings containing natural antimicrobial agents, including Manuka honey", "comparator": "", "primaryOutcome": "reducing wound bacterial infection and improving healing", "result": "the abstract does not report specific quantitative findings on Manuka honey's effect, only that it shows encouraging antibacterial activity", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a narrative overview of many treatments rather than a study testing Manuka honey itself, so it cannot show whether it actually works.", "directness": "indirect", "limitations": "The abstract is a general review covering many antimicrobial wound treatments (antibiotics, essential oils, honey, nanoparticles) without presenting original data, patient numbers, or direct comparisons for Manuka honey specifically; no anorectal surgery context is mentioned.", "followUp": "", "plainFinding": "Review mentions honey, no clear result.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30231567/", "sourceText": "The treatment of skin wounds is a key research domain owing to the important functional and aesthetic role of this tissue. When the skin is impaired, bacteria can soon infiltrate into underlying tissues which can lead to life-threatening infections. Consequently, effective treatments are necessary to deal with such pathological conditions. Recently, wound dressings loaded with antimicrobial agents have emerged as viable options to reduce wound bacterial colonization and infection, in order to improve the healing process. In this paper, we present an overview of the most prominent antibiotic-embedded wound dressings, as well as the limitations of their use. A promising, but still an underrated group of potential antibacterial agents that can be integrated into wound dressings are natural products, especially essential oils. Some of the most commonly used essential oils against multidrug-resistant microorganisms, such as tea tree, St. John's Wort, lavender and oregano, together with their incorporation into wound dressings are presented. In addition, another natural product that exhibits encouraging antibacterial activity is honey. We highlight recent results of several studies carried out by researchers from different regions of the world on wound dressings impregnated with honey, with a special emphasis on Manuka honey. Finally, we highlight recent advances in using nanoparticles as platforms to increase the effect of pharmaceutical formulations aimed at wound healing. Silver, gold, and zinc nanoparticles alone or functionalized with diverse antimicrobial compounds have been integrated into wound dressings and demonstrated therapeutic effects on wounds.", "provenance": [ { "field": "population", "quote": "The treatment of skin wounds is a key research domain" }, { "field": "intervention", "quote": "wound dressings impregnated with honey, with a special emphasis on Manuka honey" }, { "field": "primaryOutcome", "quote": "to reduce wound bacterial colonization and infection, in order to improve the healing process" }, { "field": "result", "quote": "another natural product that exhibits encouraging antibacterial activity is honey" } ] }, { "id": "pmid:29958620", "pmid": "29958620", "doi": "10.1016/j.ijporl.2018.05.026", "nctId": null, "pmcid": null, "title": "The use of honey in cochlear implant associated wounds in pediatric patients", "firstAuthor": "Costeloe", "multipleAuthors": true, "journal": "Int J Pediatr Otorhinolaryngol", "year": 2018, "design": "case-series", "n": 3, "nField": "reported", "population": "children with skin wounds/ulcers near cochlear implants", "intervention": "medical grade honey gel (TheraHoney) added to antibiotic treatment", "comparator": "standard antibiotic treatment alone (before honey added)", "primaryOutcome": "complete wound closure without surgery", "result": "all three patients' wounds fully healed without needing surgical repair", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "Only three patients with no comparison group, so it's hard to know if honey caused the healing.", "directness": "indirect", "limitations": "Very small retrospective case series of only 3 patients, no control group, different wound type (cochlear implant skin ulcers, not anorectal surgical wounds).", "followUp": "", "plainFinding": "Healed cochlear implant skin ulcers.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29958620/", "sourceText": "INTRODUCTION: The use of honey in wound care is becoming more common due to the proven benefit in all three phases of wound healing, as well as the antibacterial and antibiofilm properties. We present our experience using TheraHoney gel, a medical grade honey, for the successful treatment of cochlear implant associated skin breakdown. OBJECTIVE: To describe the role of TheraHoney gel in the management of cutaneous infection and ulceration associated with cochlear implants. METHODS: Three cases of wounds treated traditionally with antibiotics, plus the addition of TheraHoney, were retrospectively reviewed. The first patient had a superficial 1 × 1 cm ulcer, the second patient had bilateral ulcers: one superficial 1.5 × 1.5 cm ulcer and the other a 1.5 × 2 cm stage III pressure ulcer with an exposed receiver stimulator, and the third patient with a 3 × 3.5 cm stage III ulcer with an exposed receiver stimulator. RESULTS: With the addition of TheraHoney gel, complete wound closure was achieved at all three patients without the need for surgical reconstruction. CONCLUSION: Cutaneous infection with or without skin breakdown is a common delayed complication after cochlear implantation. We demonstrate the efficacy of adding medical grade honey in promoting healing in infected scalp pressure ulcers overlying the cochlear implant site.", "provenance": [ { "field": "n", "quote": "Three cases of wounds treated traditionally with antibiotics, plus the addition of TheraHoney, were retrospectively reviewed." }, { "field": "population", "quote": "cutaneous infection and ulceration associated with cochlear implants" }, { "field": "intervention", "quote": "We present our experience using TheraHoney gel, a medical grade honey, for the successful treatment of cochlear implant associated skin breakdown." }, { "field": "comparator", "quote": "Three cases of wounds treated traditionally with antibiotics, plus the addition of TheraHoney, were retrospectively reviewed." }, { "field": "primaryOutcome", "quote": "complete wound closure was achieved at all three patients without the need for surgical reconstruction" }, { "field": "result", "quote": "With the addition of TheraHoney gel, complete wound closure was achieved at all three patients without the need for surgical reconstruction." } ] }, { "id": "pmid:29738292", "pmid": "29738292", "doi": "10.12968/jowc.2018.27.5.320", "nctId": null, "pmcid": null, "title": "Comparison of antimicrobial activity of selected, commercially available wound dressing materials", "firstAuthor": "Szweda", "multipleAuthors": true, "journal": "J Wound Care", "year": 2018, "design": "lab", "n": null, "nField": "not-reported", "population": "bacteria samples in laboratory testing (not patients)", "intervention": "wound dressing containing manuka honey (Algivon)", "comparator": "other wound dressings containing silver, chlorhexidine acetate, or povidone-iodine", "primaryOutcome": "ability to kill or inhibit bacteria", "result": "Manuka honey dressing showed high antibacterial activity in one lab test (disc diffusion) but this wasn't confirmed in the other test (time-killing assay); silver and povidone-iodine dressings performed better overall", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "This is a lab test on bacteria in dishes, not a study on patients or wounds healing.", "directness": "indirect", "limitations": "In-vitro testing only against reference bacterial strains, not tested in actual wounds or patients, no healing outcomes measured.", "followUp": "", "plainFinding": "Mixed antibacterial results in lab test only.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29738292/", "sourceText": "OBJECTIVE: The aim of our study was to examine the antimicrobial potential of eight selected, commercially available wound dressings containing different antimicrobial agents: silver, chlorhexidine acetate, povidone-iodine, and manuka honey. METHOD: The materials were tested against four reference strains of bacteria: Staphylococcus aureus (PCM 2051), Staphylococcus epidermidis (PCM 2118), Pseudomonas aeruginosa (ATCC 27853), and Escherichia coli (K12), using the disc diffusion-like method and a time-killing assay. RESULTS: For both experiments, the highest activity against all four tested strains of bacteria was observed in the case of Mepilex Ag, which contains silver as an antibacterial agent. Incubation for four hours of a 10x10mm2 piece of this material in 10ml cells suspension (concentration: 109-1010CFU/ml) resulted in complete elimination of bacteria of all four strains tested. The same results were obtained for a povidone-iodine containing dressing, Inadine, though its activity was lower in the disc diffusion assay. Silvercel, Aquacel Ag and Melgisorb Ag, which also contain silver, also exhibited a satisfactory level of activity. In the case of Aquacel Ag, 24 hours' incubation resulted in complete elimination of the cells of both Gram-negative bacteria, Escherichia coli and Pseudomonas aeruginosa.The Escherichia coli cells were killed after only four hours' treatment. High effectiveness against Escherichia coli was also demonstrated for Silvercel. However, 24 hours' includation was required for complete elimination of the cells of this bacteria strain. High activity against all tested bacteria, but only in the disc diffusion assay, was observed for Algivon, which contains manuka honey. The Medisorb Silver Pad, containing silver, and Bactigras, which contains chlorhexidine acetate, revealed much lower antimicrobial activity, particularly noticeable in the time-killing assay. In addition, we also tested the anti-staphylococcal activity of a biopolymer material impregnated with lysostaphin. Results revealed that its activity against Staphylococcus aureus was comparable to the most active wound dressings impregnated with silver or inadine. CONCLUSION: Some important differences in the antimicrobial potential of investigated materials have been found. The presented results could be of interest to clinicians managing wounds.", "provenance": [ { "field": "population", "quote": "four reference strains of bacteria: Staphylococcus aureus (PCM 2051), Staphylococcus epidermidis (PCM 2118), Pseudomonas aeruginosa (ATCC 27853), and Escherichia coli (K12)" }, { "field": "intervention", "quote": "Algivon, which contains manuka honey" }, { "field": "comparator", "quote": "silver, chlorhexidine acetate, povidone-iodine, and manuka honey" }, { "field": "primaryOutcome", "quote": "examine the antimicrobial potential of eight selected, commercially available wound dressings" }, { "field": "result", "quote": "High activity against all tested bacteria, but only in the disc diffusion assay, was observed for Algivon, which contains manuka honey." } ] }, { "id": "pmid:29727650", "pmid": "29727650", "doi": "10.1016/j.ijbiomac.2018.04.149", "nctId": null, "pmcid": null, "title": "Mechanical, structural and physical aspects of chitosan-based films as antimicrobial dressings", "firstAuthor": "Escárcega-Galaz", "multipleAuthors": true, "journal": "Int J Biol Macromol", "year": 2018, "design": "lab", "n": null, "nField": "not-reported", "population": "Not patients; laboratory testing of chitosan-based film material against bacteria", "intervention": "Chitosan films formulated with a glycerol-honey mixture", "comparator": "Pure chitosan films without honey", "primaryOutcome": "Mechanical, physical, and antimicrobial properties of the film material", "result": "Films with honey showed increased antimicrobial contact area (to 44%) and improved elongation, but antimicrobial effect occurred only by direct contact", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a laboratory materials study testing film properties against bacteria in a dish, not a clinical study of wound healing in patients.", "directness": "indirect", "limitations": "No human or animal wound healing was tested; honey type not specified as manuka; no clinical outcomes reported.", "followUp": "", "plainFinding": "Lab material test, not clinical healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29727650/", "sourceText": "Chitosan is a biodegradable, non-toxic, and antimicrobial polymer. Chitosan films can be used as a dressing because they promote the healing of cutaneous ulcers. In this study, the mechanical, physical, and microbiological properties films of pure chitosan and films formulated with a glycerol-honey mixture were characterized. The films were smooth, homogenous, transparent, and porous, with no fractures or cracks. Additionally, it was found that all were resistant to breaking, that the tearing force was directly related to the chitosan concentration, and that the addition of honey and glycerol improved the elongation percentage. When evaluating the antimicrobial activity of the films against Pseudomonas aeruginosa and Klebsiella pneumoniae, the films were found to have an effect only by direct contact. In the films formulated with honey, the area of contact increased to 44%. The excellent color, structural, antimicrobial, and surface morphological properties of the newly developed films make them a promising alternative for use as a dressing for the healing of skin ulcers.", "provenance": [ { "field": "intervention", "quote": "films formulated with a glycerol-honey mixture were characterized" }, { "field": "comparator", "quote": "films of pure chitosan" }, { "field": "primaryOutcome", "quote": "the mechanical, physical, and microbiological properties films" }, { "field": "result", "quote": "the films were found to have an effect only by direct contact. In the films formulated with honey, the area of contact increased to 44%" }, { "field": "population", "quote": "evaluating the antimicrobial activity of the films against Pseudomonas aeruginosa and Klebsiella pneumoniae" } ] }, { "id": "pmid:29718813", "pmid": "29718813", "doi": null, "nctId": null, "pmcid": null, "title": "Efficacy of Honeydew Honey and Blossom Honey on Full-thickness Wound Healing in Mice", "firstAuthor": "Sawazaki", "multipleAuthors": true, "journal": "Wounds", "year": 2018, "design": "animal", "n": 140, "nField": "reported", "population": "mice with full-thickness skin wounds", "intervention": "honey treatments (honeydew honey, Acacia honey, Manuka honey, Japanese Pharmacopoeia honey) applied to wounds", "comparator": "gauze dressing or hydrocolloid dressing (no honey)", "primaryOutcome": "wound healing over 14 days, including wound area, reepithelialization, and collagen deposition", "result": "all honey groups showed reepithelialization rates of less than 40%, numerous neutrophils, weak wound contraction, and impaired collagen deposition after day 11, and were less effective at promoting full-thickness wound healing than the controls", "resultDirection": "harm", "quality": "low", "qualityWhy": "This is a small mouse experiment, not a human study, so it cannot directly tell us how honey affects human surgical wounds.", "directness": "indirect", "limitations": "Animal (mouse) model of full-thickness skin wounds, not human anorectal surgical wounds; abstract does not describe blinding or statistical details.", "followUp": "14 days", "plainFinding": "Slower healing than standard dressings.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29718813/", "sourceText": "INTRODUCTION: The wound healing properties of honey, including blossom honey, are well known; however, the effects of honeydew honey during the wound healing process have not yet been investigated and thus remain unclear. OBJECTIVE: This study compares the effects of honeydew honey with those of blossom honey. MATERIALS AND METHODS: A total of 140 mice were divided into 2 control groups, which received either a hydrocolloid dressing (HCD; n = 22) or gauze (n = 22), and 4 experimental groups: honeydew honey (n = 23), Acacia honey (n = 23), Manuka honey (n = 22), and Japanese Pharmacopoeia honey (n = 28). Two circular full-thickness wounds were made and measured for 14 days. Each wound in the experimental groups was treated with 0.1 mL of honey and covered with gauze. Dressings in the control and experimental groups were changed daily. RESULTS: The wounds in all of the honey groups and the HCD group were moist by day 14, while those in the gauze group were dry. The ratio of wound area to initial wound area and the number of inflammatory cells decreased during the inflammatory phase in all honey groups. However, the honey groups exhibited reepithelialization rates of < 40%, numerous neutrophils, weak wound contraction, and impaired collagen deposition in wounds after day 11. CONCLUSIONS: These results suggest honeydew honey and blossom honey both exert anti-inflammatory effects during the inflammatory phase. However, all of the honeys examined were less effective at promoting full-thickness wound healing than the controls. Further studies are warranted.", "provenance": [ { "field": "n", "quote": "A total of 140 mice were divided into 2 control groups, which received either a hydrocolloid dressing (HCD; n = 22) or gauze (n = 22), and 4 experimental groups: honeydew honey (n = 23), Acacia honey (n = 23), Manuka honey (n = 22), and Japanese Pharmacopoeia honey (n = 28)." }, { "field": "population", "quote": "Two circular full-thickness wounds were made and measured for 14 days." }, { "field": "intervention", "quote": "Each wound in the experimental groups was treated with 0.1 mL of honey and covered with gauze." }, { "field": "comparator", "quote": "2 control groups, which received either a hydrocolloid dressing (HCD; n = 22) or gauze (n = 22)" }, { "field": "primaryOutcome", "quote": "Two circular full-thickness wounds were made and measured for 14 days." }, { "field": "result", "quote": "the honey groups exhibited reepithelialization rates of < 40%, numerous neutrophils, weak wound contraction, and impaired collagen deposition in wounds after day 11" }, { "field": "result", "quote": "all of the honeys examined were less effective at promoting full-thickness wound healing than the controls" } ] }, { "id": "pmid:29578463", "pmid": "29578463", "doi": "10.3233/BME-181730", "nctId": null, "pmcid": null, "title": "Pectin-honey hydrogel: Characterization, antimicrobial activity and biocompatibility", "firstAuthor": "Giusto", "multipleAuthors": true, "journal": "Biomed Mater Eng", "year": 2018, "design": "lab", "n": null, "nField": "not-reported", "population": "cultured fibroblast cells and rats (not human patients)", "intervention": "a pectin-honey hydrogel wound dressing", "comparator": "no comparator treatment described", "primaryOutcome": "material properties including antibacterial activity, biocompatibility and tissue tolerance", "result": "the hydrogel was non-toxic to fibroblasts, showed antibacterial activity against bacteria, and caused no harmful inflammatory or tissue changes in rats", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is an early-stage lab and animal material-testing study with no comparator and no human wound-healing outcome measured.", "directness": "indirect", "limitations": "no human patients, no wound-healing outcome measured, no comparison group, and the number of animals used is not reported.", "followUp": "", "plainFinding": "Material shown safe, not tested for healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29578463/", "sourceText": "BACKGROUND: Novel pectin-honey hydrogels have been developed and characterized as medical device. Ideally, a wound dressing should maintain optimal fluid affinity, permit moisture evaporation, protect the wound from microbes, and have shape-conformability, biocompatibility, and antibacterial activity. OBJECTIVE: A novel, simple and fast method to produce pectin-honey wound dressings is described. METHODS: The properties of these pectin-honey hydrogels were investigated, including swelling ability, water vapour transmission rate, hydrogen peroxide production, methylglyoxal content and antibacterial activity. Biocompatibility was assessed by proliferation assays using cultured fibroblast cells and by in vivo study with subcutaneous and intraperitoneal implantation in rats. RESULTS: Hydrogel showed a good water vapour transmission rate, fluid uptake and were not cytotoxic for fibroblasts. The hydrogel demonstrated good antibacterial activity toward clinically relevant pathogens, including S. aureus and E. coli. Biocompatibility was confirmed by the measurement of plasma levels of interleukin (IL)1 beta, IL-6, tumour necrosis factor (TNF) alpha, and prostaglandin (PG)E2. No histological changes were observed. CONCLUSIONS: The presence of a natural active component, conformability, and complete resorbability are the main characteristics of this new biocompatible biomaterial that is well tolerated by the body, possibly improves healing, may be used for surgical complications prevention, with a simple and inexpensive production process.", "provenance": [ { "field": "population", "quote": "cultured fibroblast cells and by in vivo study with subcutaneous and intraperitoneal implantation in rats" }, { "field": "intervention", "quote": "Novel pectin-honey hydrogels have been developed and characterized as medical device" }, { "field": "comparator", "quote": "BACKGROUND: Novel pectin-honey hydrogels have been developed and characterized as medical device." }, { "field": "primaryOutcome", "quote": "including swelling ability, water vapour transmission rate, hydrogen peroxide production, methylglyoxal content and antibacterial activity" }, { "field": "result", "quote": "Hydrogel showed a good water vapour transmission rate, fluid uptake and were not cytotoxic for fibroblasts. The hydrogel demonstrated good antibacterial activity toward clinically relevant pathogens, including S. aureus and E. coli." }, { "field": "result", "quote": "No histological changes were observed." } ] }, { "id": "pmid:29498972", "pmid": "29498972", "doi": "10.1097/SCS.0000000000004393", "nctId": null, "pmcid": null, "title": "Comparing the Efficacy of Peritonsillar Injection of Tramadol With Honey in Controlling Post-Tonsillectomy Pain in Adults", "firstAuthor": "Hatami", "multipleAuthors": true, "journal": "J Craniofac Surg", "year": 2018, "design": "rct", "n": 60, "nField": "reported", "population": "Adults aged 18 to 55 having tonsil removal surgery", "intervention": "Honey taken by mouth after surgery plus acetaminophen", "comparator": "Tramadol injected into the tonsil area during surgery", "primaryOutcome": "Pain levels and wound healing of the tonsil area after surgery", "result": "Pain was higher in the honey group during the first 24 hours; by 7 days pain was similar between groups, and healing of the tonsil area did not differ significantly between groups, though it looked slightly better with tramadol by day 7", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small study of 60 patients with no mention of blinding, and it studied tonsillectomy pain rather than anorectal wound healing with manuka honey specifically.", "directness": "indirect", "limitations": "Small sample size, no blinding described, outcome measured only to 7 days, and honey type not specified as manuka honey.", "followUp": "7 days", "plainFinding": "No clear healing benefit from honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29498972/", "sourceText": "INTRODUCTION: The authors investigated the effect of honey on post-tonsillectomy pain and compare its efficacy with tramadol. METHODS: This clinical trial was performed on 60 patients with American Society of Anesthesia I and II aged between 18 and 55 years and underwent tonsillectomy. Induction of anesthesia was carried out using 2 mg/kg propofol and 0.5 atracurium following 1.5 μg/kg fentanyl administration. Group B was given tramadol at dose of 2 mg/kg and with volume of 4 mL and Group A was given normal saline with the same volume 2 mL of medications were injected using needle (25) into tonsil bed and anterior old of each tonsil by an anesthesiologist. Three minutes after injection, the surgery was performed by the same ENT residents for all patients. In the recovery room Group B received antibiotics and oral acetaminophen. Group A was given antibiotics, oral acetaminophen, and honey dissolved in 40 mL warm water every 6 hours from when the patient was fully awake. Patients in Group A were told to eat honey 3 times a day 7 days postoperatively. Pain was scored using Numeric Rating Scale at the time points of 2, 6, 12, and 24 hours as well as 3 and 7 days postoperatively. Moreover, the healing status and epithelialization degree of tonsillar bed were considered on 1 and 7 days after the surgery by ENT specialist. RESULTS: The mean of pain score was significantly higher in Group A within 24 hours postoperatively as compared with Group B (P < 0.01). The mean of pain score was lower in Group B after 3 and 7 days but this difference was not statistically significant (P > 0.05). Considering restoration status and epithelialization degree of tonsillar bed on the 1st and 7th days, there was no statistically significant difference between 2 groups; however, tonsillar bed healing process was better in Group B on the 7th day. CONCLUSION: The current investigation confirmed the positive impact of tramadol on post-tonsillectomy pain relief in adults. The authors also found that honey can be used as a complementary treatment along with acetaminophen and other analgesics for reducing post-tonsillectomy pain. Considering honey impact on wound healing and its anti-inflammatory effect, it is suggested for relieving complications after surgery.", "provenance": [ { "field": "n", "quote": "This clinical trial was performed on 60 patients" }, { "field": "population", "quote": "60 patients with American Society of Anesthesia I and II aged between 18 and 55 years and underwent tonsillectomy" }, { "field": "intervention", "quote": "honey dissolved in 40 mL warm water every 6 hours from when the patient was fully awake. Patients in Group A were told to eat honey 3 times a day 7 days postoperatively" }, { "field": "comparator", "quote": "Group B was given tramadol at dose of 2 mg/kg and with volume of 4 mL" }, { "field": "primaryOutcome", "quote": "Pain was scored using Numeric Rating Scale at the time points of 2, 6, 12, and 24 hours as well as 3 and 7 days postoperatively. Moreover, the healing status and epithelialization degree of tonsillar bed were considered on 1 and 7 days after the surgery" }, { "field": "result", "quote": "The mean of pain score was significantly higher in Group A within 24 hours postoperatively as compared with Group B (P < 0.01). The mean of pain score was lower in Group B after 3 and 7 days but this difference was not statistically significant (P > 0.05). Considering restoration status and epithelialization degree of tonsillar bed on the 1st and 7th days, there was no statistically significant difference between 2 groups; however, tonsillar bed healing process was better in Group B on the 7th day." } ] }, { "id": "pmid:29358534", "pmid": "29358534", "doi": "10.5005/jp-journals-10024-2210", "nctId": null, "pmcid": null, "title": "Effect of Topical Honey on Mandibular Bone Defect Healing in Rats", "firstAuthor": "Hajizadeh", "multipleAuthors": true, "journal": "J Contemp Dent Pract", "year": 2018, "design": "animal", "n": 24, "nField": "reported", "population": "rats with surgically created mandibular bone defects", "intervention": "topical honey placed in the bone defect", "comparator": "no honey, defect left unfilled", "primaryOutcome": "bone healing assessed histologically and by new bone formation", "result": "honey group showed faster healing stages and significantly more new bone formation than control at 2 and 4 weeks", "resultDirection": "benefit", "quality": "low", "qualityWhy": "small animal study on bone defects, not human wounds or manuka honey, so it offers only indirect, limited evidence for the question asked", "directness": "indirect", "limitations": "Animal model with small sample size, not manuka honey specifically, and bone defect healing rather than skin or anorectal wound healing.", "followUp": "4 weeks", "plainFinding": "Faster bone healing in rats.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29358534/", "sourceText": "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.", "provenance": [ { "field": "n", "quote": "This animal study was performed on 24 wild-type Wistar rats." }, { "field": "population", "quote": "a 2 × 2 mm defect was created at mandibular angle" }, { "field": "intervention", "quote": "In the experimental group, the defect was filled with sterile honey" }, { "field": "comparator", "quote": "while it was left unfilled in the control group" }, { "field": "primaryOutcome", "quote": "defects were assessed histologically" }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:29204567", "pmid": "29204567", "doi": "10.1016/j.wjorl.2016.07.003", "nctId": null, "pmcid": "PMC5698533", "title": "Objective and subjective scar aesthetics with topical Manuka honey post-thyroidectomy: A randomized control study", "firstAuthor": "Thamboo", "multipleAuthors": true, "journal": "World J Otorhinolaryngol Head Neck Surg", "year": 2016, "design": "rct", "n": 21, "nField": "reported", "population": "patients who had thyroid surgery with an 8 cm incision", "intervention": "Manuka honey paste applied daily to the incision for 4 weeks", "comparator": "standard treatment without honey", "primaryOutcome": "scar appearance rated by patient and by an observer (POSAS scale)", "result": "no significant difference in scar appearance between honey and standard treatment at 4 and 8 weeks", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "Very small number of patients (21) and different surgical wounds than anorectal surgery, so results carry limited weight.", "directness": "indirect", "limitations": "Small sample size (only 21 patients completed assessment); single-blinded design.", "followUp": "8 weeks", "plainFinding": "No improvement in scar appearance.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29204567/", "sourceText": "OBJECTIVE: Leptospermum Honey (Manuka honey) has proven to be effective in improving acute and chronic wound healing presumably due to its antibacterial and anti-inflammatory properties. The aim is to determine if Manuka honey decreases scar formation and results in a cosmetically appealing scar. METHODS: A prospective single-blinded randomized control trial was performed. All patients received an 8 cm incision. Patients randomized to honey treatment were instructed to apply Manuka honey paste topically to the incision site once per day post surgery for 4 weeks. The patients' scar was then analyzed objectively by a blinded observer and subjectively at 4 and 8 weeks postoperatively. The primary outcome measure used was the Patient and Observer Scar Assessment Scale (POSAS). RESULTS: A total of 21 patients completed the entire scar analysis (honey treatment = 9, standard treatment = 12). There was no statistically significant difference between patient scar assessment scale and observer scar assessment scale at 4 and 8 weeks postoperatively. CONCLUSION: Despite Leptospermum Honey's reported anti-inflammatory and antibacterial properties, this study did not show a difference in scar appearance when applied.", "provenance": [ { "field": "n", "quote": "A total of 21 patients completed the entire scar analysis (honey treatment = 9, standard treatment = 12)." }, { "field": "population", "quote": "All patients received an 8 cm incision." }, { "field": "intervention", "quote": "Patients randomized to honey treatment were instructed to apply Manuka honey paste topically to the incision site once per day post surgery for 4 weeks." }, { "field": "comparator", "quote": "standard treatment = 12" }, { "field": "primaryOutcome", "quote": "The primary outcome measure used was the Patient and Observer Scar Assessment Scale (POSAS)." }, { "field": "result", "quote": "There was no statistically significant difference between patient scar assessment scale and observer scar assessment scale at 4 and 8 weeks postoperatively." } ] }, { "id": "pmid:29049265", "pmid": "29049265", "doi": "10.1097/01.ASW.0000526158.36473.dd", "nctId": null, "pmcid": null, "title": "Medical-Grade Honey Dressing Use in Developing Countries", "firstAuthor": "Winter", "multipleAuthors": false, "journal": "Adv Skin Wound Care", "year": 2017, "design": "case-series", "n": null, "nField": "not-reported", "population": "wound care patients in developing countries, as treated by one healthcare provider in Africa", "intervention": "SurgihoneyRO, a bioengineered medical-grade honey wound dressing", "comparator": "no controlled comparator described", "primaryOutcome": "successful wound care use of the dressing", "result": "the provider has successfully used this antimicrobial dressing", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a descriptive account of one provider's experience with no data, no comparison group, and no measured outcomes.", "directness": "indirect", "limitations": "no patient numbers, no quantitative results, and the honey product described (SurgihoneyRO) is not manuka honey, nor is anorectal surgery mentioned.", "followUp": "", "plainFinding": "Honey dressing reportedly worked, no data given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29049265/", "sourceText": "Compared with other medical honeys, SurgihoneyRO (H&R Healthcare Ltd, Southmoor, Abingdon, United Kingdom), a bioengineered medical-grade honey, delivers low concentrations of reactive oxygen to wounds over a sustained period. This article describes how one provider, Dr Jill Brooks, has successfully used this new antimicrobial dressing in Africa and examines the potential positive impact this dressing could have on wound care in developing countries.", "provenance": [ { "field": "intervention", "quote": "SurgihoneyRO (H&R Healthcare Ltd, Southmoor, Abingdon, United Kingdom), a bioengineered medical-grade honey, delivers low concentrations of reactive oxygen to wounds over a sustained period" }, { "field": "population", "quote": "used this new antimicrobial dressing in Africa" }, { "field": "result", "quote": "has successfully used this new antimicrobial dressing in Africa" }, { "field": "primaryOutcome", "quote": "examines the potential positive impact this dressing could have on wound care in developing countries" }, { "field": "comparator", "quote": "Compared with other medical honeys" } ] }, { "id": "pmid:28795889", "pmid": "28795889", "doi": "10.12968/jowc.2017.26.8.442", "nctId": null, "pmcid": null, "title": "Use of an engineered honey to eradicate preformed biofilms of important wound pathogens: an in vitro study", "firstAuthor": "Halstead", "multipleAuthors": true, "journal": "J Wound Care", "year": 2017, "design": "lab", "n": null, "nField": "not-reported", "population": "Bacteria that commonly infect wounds, grown in lab dishes", "intervention": "An engineered medical honey called SurgihoneyRO applied directly to bacterial biofilms", "comparator": "Untreated bacterial biofilms (no honey)", "primaryOutcome": "Whether the honey could break down and reduce already-formed bacterial biofilms", "result": "The honey reduced biofilm regrowth and biomass for all 16 bacteria tested, with reductions of 58% to 94.3% at the strongest concentration", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a lab dish experiment on bacteria, not a study of patients or wounds, so it cannot show whether honey helps people heal.", "directness": "indirect", "limitations": "In vitro only, no patients or wounds involved, and the honey tested (SurgihoneyRO) is an engineered honey rather than plain manuka honey", "followUp": "", "plainFinding": "Killed wound bacteria in a dish.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28795889/", "sourceText": "OBJECTIVE: We previously reported on the ability of SurgihoneyRO (SHRO), an engineered honey, to prevent biofilm formation in vitro, but data were lacking regarding the activity against preformed biofilms. This study aims to assess whether SHRO has any antibacterial activity against mature, preformed biofilms and whether there is any evidence to support the observed clinical effectiveness when SHRO has been used anecdotally on acute and chronic wounds where biofilm is most likely present. METHOD: We tested the in vitro antibacterial activity of SHRO against the mature biofilms of 16 clinically relevant wound pathogens, in terms of impacts on biofilm seeding and biofilm biomass. The honey was serially double diluted from 1:3 down to 1:6144, and the lowest dilution achieving a statistically significant reduction in biomass of ≥50%, compared with untreated controls, was recorded. RESULTS: All 16 bacterial isolates were susceptible to SHRO, with reduced biofilm seeding observed for all, and percentage reductions ranging from 58% (ACI_C59) to 94.3% (MDR_B) for the strongest concentration of honey (1:3). Furthermore at this concentration, biofilm seeding of the test biofilm was reduced by 80-94.3% (when compared with the positive control) for 12/16 isolates. We additionally demonstrated that SHRO has antibiofilm impacts, with the 24 hour exposure resulting in disruption of the biofilm, reduced seeding and reduced biomass. CONCLUSION: SHRO is effective at reducing seeding of preformed biofilms of clinically important wound pathogens in vitro, and also has antibiofilm activity. This supports the anecdotal clinical data for antibiofilm efficacy, and supports the use of SHRO as a promising topical wound care agent.", "provenance": [ { "field": "population", "quote": "the mature biofilms of 16 clinically relevant wound pathogens" }, { "field": "intervention", "quote": "SurgihoneyRO (SHRO), an engineered honey" }, { "field": "comparator", "quote": "compared with untreated controls" }, { "field": "primaryOutcome", "quote": "to assess whether SHRO has any antibacterial activity against mature, preformed biofilms" }, { "field": "result", "quote": "percentage reductions ranging from 58% (ACI_C59) to 94.3% (MDR_B) for the strongest concentration of honey (1:3)" }, { "field": "n", "quote": "16 clinically relevant wound pathogens" } ] }, { "id": "pmid:28532035", "pmid": "28532035", "doi": "10.1016/j.msec.2017.03.272", "nctId": null, "pmcid": null, "title": "Honey/PVA hybrid wound dressings with controlled release of antibiotics: Structural, physico-mechanical and in-vitro biomedical studies", "firstAuthor": "Tavakoli", "multipleAuthors": true, "journal": "Mater Sci Eng C Mater Biol Appl", "year": 2017, "design": "lab", "n": null, "nField": "not-reported", "population": "Not a patient study; laboratory testing of a wound dressing material", "intervention": "Honey and PVA hybrid hydrogel wound dressing with borax crosslinking", "comparator": "Different crosslinking densities of the same hydrogel (varying borax percentage)", "primaryOutcome": "Physical, mechanical and biological properties of the dressing (swelling, permeability, bio-adhesion, cytotoxicity, antibacterial effect, cell proliferation)", "result": "The hydrogel with 1% borax showed the best overall properties and all versions were biocompatible in lab tests", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a laboratory material-science study with no patients, so it cannot show whether honey helps real wounds heal.", "directness": "indirect", "limitations": "In-vitro only; no human or animal wound healing data; not specific to manuka honey or anorectal surgery", "followUp": "", "plainFinding": "Lab test of honey dressing material.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28532035/", "sourceText": "Hydrogel/honey hybrids manifest an attractive design with an exclusive therapeutic property that promotes wound healing process. The greater the concentration of honey within the formulation, the better the biomedical properties that will be achieved. However, an increase in the percentage of honey can negatively affect the physico-chemical and mechanical properties of hybrid hydrogels. The need exists, therefore, to prepare wound dressings that contain high honey density with optimal biomedical, mechanical and physicochemical properties. In this study, a simple method for the preparation of a highly concentrated honey/PVA hybrid hydrogel with borax as the crosslinking agent is reported. Comprehensive evaluations of the morphology, swelling kinetics, permeability, bio-adhesion, mechanical characteristics, cytotoxicity, antibacterial property, cell proliferation ability and their controlling release properties were conducted as a function of crosslinking density. All the borax-induced hydrogels showed acceptable biocompatibility, and the incorporation of 1% borax in the hydrogel formulation produced optimal behaviours for wound addressing applications.", "provenance": [ { "field": "population", "quote": "Comprehensive evaluations of the morphology, swelling kinetics, permeability, bio-adhesion, mechanical characteristics, cytotoxicity, antibacterial property, cell proliferation ability and their controlling release properties were conducted" }, { "field": "intervention", "quote": "a simple method for the preparation of a highly concentrated honey/PVA hybrid hydrogel with borax as the crosslinking agent is reported" }, { "field": "comparator", "quote": "conducted as a function of crosslinking density" }, { "field": "primaryOutcome", "quote": "Comprehensive evaluations of the morphology, swelling kinetics, permeability, bio-adhesion, mechanical characteristics, cytotoxicity, antibacterial property, cell proliferation ability and their controlling release properties were conducted" }, { "field": "result", "quote": "All the borax-induced hydrogels showed acceptable biocompatibility, and the incorporation of 1% borax in the hydrogel formulation produced optimal behaviours for wound addressing applications." } ] }, { "id": "pmid:28511700", "pmid": "28511700", "doi": "10.1186/s12906-017-1769-1", "nctId": null, "pmcid": "PMC5433168", "title": "A new, easy-to-make pectin-honey hydrogel enhances wound healing in rats", "firstAuthor": "Giusto", "multipleAuthors": true, "journal": "BMC Complement Altern Med", "year": 2017, "design": "animal", "n": 36, "nField": "reported", "population": "Rats with surgically created skin wounds on their backs", "intervention": "Liquid Manuka honey applied to the wound, compared with a new pectin-honey hydrogel", "comparator": "Pectin hydrogel alone or bandage-only control", "primaryOutcome": "Speed of wound area reduction (healing rate)", "result": "Wound healing was faster with honey and with the pectin-honey hydrogel than with control, but only the hydrogel group reached statistical significance", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small animal (rat) study with wounds surgically created, not a clinical trial in humans, so it says little about human anorectal surgery wounds.", "directness": "indirect", "limitations": "Animal model only, small group sizes, and the liquid honey group's improvement over control was not reported as statistically significant.", "followUp": "", "plainFinding": "Honey hydrogel sped healing; honey alone unclear.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28511700/", "sourceText": "BACKGROUND: Honey, alone or in combination, has been used for wound healing since ancient times and has reemerged as a topic of interest in the last decade. Pectin has recently been investigated for its use in various biomedical applications such as drug delivery, skin protection, and scaffolding for cells. The aim of the present study was to develop and evaluate a pectin-honey hydrogel (PHH) as a wound healing membrane and to compare this dressing to liquid honey. METHODS: Thirty-six adult male Sprague-Dawley rats were anesthetized and a 2 × 2 cm excisional wound was created on the dorsum. Animals were randomly assigned to four groups (PHH, LH, Pec, and C): in the PHH group, the pectin-honey hydrogel was applied under a bandage on the wound; in the LH group, liquid Manuka honey was applied; in the Pec group, pectin hydrogel was applied (Pec); and in the C group, only bandage was applied to the wound. Images of the wound were taken at defined time points, and the wound area reduction rate was calculated and compared between groups. RESULTS: The wound area reduction rate was faster in the PHH, LH, and Pec groups compared to the control group and was significantly faster in the PHH group. Surprisingly, the Pec group exhibited faster wound healing than the LH group, but this effect was not statistically significant. CONCLUSION: This is the first study using pectin in combination with honey to produce biomedical hydrogels for wound treatment. The results indicate that the use of PHH is effective for promoting and accelerating wound healing.", "provenance": [ { "field": "population", "quote": "Thirty-six adult male Sprague-Dawley rats were anesthetized and a 2 × 2 cm excisional wound was created on the dorsum." }, { "field": "intervention", "quote": "in the LH group, liquid Manuka honey was applied" }, { "field": "comparator", "quote": "in the C group, only bandage was applied to the wound" }, { "field": "primaryOutcome", "quote": "the wound area reduction rate was calculated and compared between groups" }, { "field": "result", "quote": "The wound area reduction rate was faster in the PHH, LH, and Pec groups compared to the control group and was significantly faster in the PHH group." }, { "field": "n", "quote": "Thirty-six adult male Sprague-Dawley rats were anesthetized" } ] }, { "id": "pmid:28506082", "pmid": "28506082", "doi": "10.1177/1938640017709907", "nctId": null, "pmcid": null, "title": "Novel Use of Active Leptospermum Honey for Ringed Fixator Pin Site Care in Diabetic Charcot Deformity Patients", "firstAuthor": "Lazarides", "multipleAuthors": true, "journal": "Foot Ankle Spec", "year": 2018, "design": "case-series", "n": 19, "nField": "reported", "population": "diabetic patients with Charcot deformities of the lower extremity undergoing surgery with external fixation pins", "intervention": "Leptospermum honey-impregnated dressings applied at the pin sites", "comparator": "standard pin site care in a retrospective group of patients who didn't get honey dressings", "primaryOutcome": "rate of pin site infections", "result": "infection rates were significantly reduced compared to the standard care control group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a small, non-randomized pilot study comparing a prospective group to a separate retrospective control group, so bias and chance can't be ruled out.", "directness": "indirect", "limitations": "Pilot data in a prospectively collected case series; authors say a randomized controlled study is still needed; control group was evaluated retrospectively rather than randomized.", "followUp": "12.1 weeks", "plainFinding": "Fewer pin site infections with honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28506082/", "sourceText": "INTRODUCTION: Open reduction with external fixation (OREF) utilizing fine wire ringed fixators for correction of Charcot deformity has gained popularity over the past decade. Pin site infections are a well-documented complication of external fixation as well as a driver of escalating health care costs. We aimed to demonstrate the safety and efficacy of a novel method of pin site care utilizing active Leptospermum honey-impregnated dressings (MediHoney) in diabetic patients undergoing deformity correction with OREF. METHODS: Twenty-one diabetic patients with Charcot deformities of the lower extremity were prospectively enrolled and followed for pin site complications following OREF for deformity correction. Active Leptospermum honey dressings were applied at metal-cutaneous interfaces at the end of the OREF procedure and replaced weekly for a total of 8 weeks. Patients were monitored for pin site infections from the time of surgery until external fixator removal. Sixteen consecutive patients receiving standard OREF for Charcot deformities were evaluated retrospectively to serve as a control group. RESULTS: Of the 21 enrolled patients, 19 underwent OREF and followed up throughout the study period. Treated patients had a mean age of 58.5 years and mean body mass index measuring 33.3 kg/m2 as documented prior to surgery. The 15 patients with hemoglobin A1c labs drawn in the 3 months preceding surgery averaged 7.5. Fixators were removed at an average of 12.1 weeks after adequate bony healing. Of the 244 pin sites in 19 patients, 3 pin sites (1.2% of pins) in 2 patients (10.5% of patients) showed evidence of superficial infection. All infections resolved with oral antibiotics. Infection rates were significantly reduced when compared to the standard care control group. CONCLUSIONS: Pilot data in a prospectively collected case series demonstrate safety and efficacy of active Leptospermum honey-impregnated dressings when used for fine wire ringed fixator pin site care in diabetic Charcot deformity patients. Further investigation in the form of a prospective randomized controlled study is warranted to demonstrate the potential value of this novel intervention. LEVELS OF EVIDENCE: Level IV.", "provenance": [ { "field": "n", "quote": "Of the 21 enrolled patients, 19 underwent OREF and followed up throughout the study period." }, { "field": "population", "quote": "Twenty-one diabetic patients with Charcot deformities of the lower extremity" }, { "field": "intervention", "quote": "Active Leptospermum honey dressings were applied at metal-cutaneous interfaces at the end of the OREF procedure and replaced weekly for a total of 8 weeks." }, { "field": "comparator", "quote": "Sixteen consecutive patients receiving standard OREF for Charcot deformities were evaluated retrospectively to serve as a control group." }, { "field": "primaryOutcome", "quote": "We aimed to demonstrate the safety and efficacy of a novel method of pin site care utilizing active Leptospermum honey-impregnated dressings (MediHoney) in diabetic patients undergoing deformity correction with OREF." }, { "field": "result", "quote": "Infection rates were significantly reduced when compared to the standard care control group." } ] }, { "id": "pmid:28379095", "pmid": "28379095", "doi": "10.12968/jowc.2017.26.4.168", "nctId": null, "pmcid": null, "title": "An insight into the antibiofilm properties of Costa Rican stingless bee honeys", "firstAuthor": "Zamora", "multipleAuthors": true, "journal": "J Wound Care", "year": 2017, "design": "lab", "n": 57, "nField": "reported", "population": "laboratory-grown Staphylococcus aureus biofilm (not human patients)", "intervention": "Costa Rican stingless bee (Meliponini) honeys, especially Tetragonisca angustula honey", "comparator": "Medihoney (manuka-derived reference honey) and antibiotics alone", "primaryOutcome": "ability to inhibit bacterial growth and destroy Staphylococcus aureus biofilm in lab assays", "result": "Tetragonisca angustula honeys inhibited bacterial growth and biofilm formation, destroyed existing biofilm, and helped restore antibiotic effectiveness, due to two bee-derived proteins", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a laboratory dish study of honey against bacteria, not a study in people with wounds, so it cannot show whether it helps real wounds heal.", "directness": "indirect", "limitations": "In-vitro laboratory study only, no human or animal wound testing, no clinical outcomes measured.", "followUp": "", "plainFinding": "Breaks down bacterial biofilm in lab tests.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28379095/", "sourceText": "OBJECTIVE: There is an increasing search for antibiofilm agents that either have specific activity against biofilms or may act in synergy with antimicrobials. Our objective is to examine the the antibiofilm properties of stingless bee honeys. METHOD: Meliponini honeys from Costa Rica were examined along with Medihoney as a reference. All honeys were submitted to a screening composed of minimum inhibitory concentration, inhibition of biofilm formation and biofilm destruction microplate-based assays against a Staphylococcus aureus biofilm forming strain. Dialysis led to the isolation of an antibiofilm fraction in Tetragonisca angustula honeys. The honey antibiofilm fraction was evaluated for protease activity and for any synergistic effect with antibiotics on a Staphylococcus aureus biofilm. The active fraction was then separated through activity guided isolation techniques involving SDS-PAGEs, anion exchange and size exclusion fast protein liquid chromatographies. The fractions obtained and the isolated antibiofilm constituents were tested for amylase and DNase activity. RESULTS: A total of 57 Meliponini honeys from Costa Rica were studied in this research. The honeys studied belonged to the Tetragonisca angustula (n=36) and Melipona beecheii (n=21) species. Costa Rican Tetragonisca angustula honeys can inhibit the planktonic growth, biofilm formation, and are capable of destroying a Staphylococcus aureus biofilm. The antibiofilm effect was observed in the protein fraction of Tetragonisca angustula honeys. The biofilm destruction proteins allowed ampicillin and vancomycin to recover their antimicrobial activity over a Staphylococcus aureus biofilm. The antibiofilm proteins are of bee origin, and their activity was not due to serine, cysteine or metalloproteases. There were 2 proteins causing the antibiofilm action; these were named the Tetragonisca angustula biofilm destruction factors (TABDFs). TABDF-1 is a monomeric protein of approximately 50kDa that is responsible of the amylase activity of Tetragonisca angustula honeys. TABDF-2 is a protein monomer of approximately 75kDa. CONCLUSION: Tetragonisca angustula honeys from Costa Rica are a promising candidate for research and development of novel wound dressings focused on the treatment of acute and chronic Staphylococcus aureus biofilm wound infections.", "provenance": [ { "field": "population", "quote": "Staphylococcus aureus biofilm forming strain" }, { "field": "intervention", "quote": "Meliponini honeys from Costa Rica were examined along with Medihoney as a reference" }, { "field": "comparator", "quote": "Medihoney as a reference" }, { "field": "primaryOutcome", "quote": "minimum inhibitory concentration, inhibition of biofilm formation and biofilm destruction microplate-based assays against a Staphylococcus aureus biofilm forming strain" }, { "field": "result", "quote": "Costa Rican Tetragonisca angustula honeys can inhibit the planktonic growth, biofilm formation, and are capable of destroying a Staphylococcus aureus biofilm." }, { "field": "n", "quote": "A total of 57 Meliponini honeys from Costa Rica were studied in this research." } ] }, { "id": "pmid:28239398", "pmid": "28239398", "doi": "10.1155/2017/5294890", "nctId": null, "pmcid": "PMC5296609", "title": "A Pilot Randomized, Controlled Study of Nanocrystalline Silver, Manuka Honey, and Conventional Dressing in Healing Diabetic Foot Ulcer", "firstAuthor": "Tsang", "multipleAuthors": true, "journal": "Evid Based Complement Alternat Med", "year": 2017, "design": "rct", "n": 31, "nField": "reported", "population": "adults with type 2 diabetes who had diabetic foot ulcers", "intervention": "Manuka honey dressing", "comparator": "nanocrystalline silver dressing and conventional dressing", "primaryOutcome": "complete healing of the foot ulcer and reduction in ulcer size", "result": "50% of the manuka honey group had complete healing and ulcer size shrank by about 86%, compared with 40% healing and about 75% size reduction with conventional dressing, while silver dressing performed best (81.8% healing, 97% size reduction)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a very small, open-label pilot trial with only 10 people per group and no statistical comparison reported between the healing rates.", "directness": "indirect", "limitations": "Pilot study with small sample size, open-label design, and no significance testing reported for differences in healing between groups.", "followUp": "12 weeks", "plainFinding": "Honey healed more ulcers than standard care, less than silver.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28239398/", "sourceText": "Nanocrystalline silver (nAg) and Manuka honey (MH) dressing have increasing popularity for treating diabetic foot ulcer (DFU). This study was an open-label randomized controlled trial with three parallel groups' design in examining the preliminary effectiveness of nAg against MH and conventional dressing in healing DFU in terms of ulcer healing, ulcer infection, and inflammation. 31 participants (11 in the nAg group, 10 in the MH group, and 10 in the convention group) diagnosed with type 2 diabetes were enrolled. Wound cleaning, debridement, and topical dressing application were performed according to the group allocation in each visit at weeks 1, 2, 3, 4, 6, 8, 10, and 12. The results found that the proportions of complete ulcer healing were 81.8%, 50%, and 40% in the nAg, MH, and conventional groups, respectively. The ulcer size reduction rate was potentially higher in the nAg group (97.45%) than the MH group (86.21%) and the conventional group (75.17%). In bacteriology, nAg showed a greater rate of microorganism reduction although it was not significant. To conclude, nAg alginate was potentially superior to MH and conventional dressing in healing diabetic foot ulcer in terms of ulcer size reduction rate.", "provenance": [ { "field": "n", "quote": "31 participants (11 in the nAg group, 10 in the MH group, and 10 in the convention group) diagnosed with type 2 diabetes were enrolled." }, { "field": "population", "quote": "diagnosed with type 2 diabetes" }, { "field": "intervention", "quote": "Manuka honey (MH) dressing" }, { "field": "comparator", "quote": "Nanocrystalline silver (nAg) and Manuka honey (MH) dressing have increasing popularity for treating diabetic foot ulcer (DFU)." }, { "field": "primaryOutcome", "quote": "examining the preliminary effectiveness of nAg against MH and conventional dressing in healing DFU in terms of ulcer healing, ulcer infection, and inflammation" }, { "field": "result", "quote": "the proportions of complete ulcer healing were 81.8%, 50%, and 40% in the nAg, MH, and conventional groups, respectively. The ulcer size reduction rate was potentially higher in the nAg group (97.45%) than the MH group (86.21%) and the conventional group (75.17%)." } ] }, { "id": "pmid:27852015", "pmid": "27852015", "doi": null, "nctId": null, "pmcid": null, "title": "Effectiveness of Changing the Application of Japanese Honey to a Hydrocolloid Dressing in Between the Inflammatory and Proliferative Phases on Cutaneous Wound Healing in Male Mice", "firstAuthor": "Mukai", "multipleAuthors": true, "journal": "Wounds", "year": 2017, "design": "animal", "n": null, "nField": "not-reported", "population": "male mice with full-thickness skin wounds", "intervention": "Japanese honey (acacia, buckwheat flour, or Chinese milk vetch) applied for 3 days then covered with a hydrocolloid dressing", "comparator": "hydrocolloid dressing alone", "primaryOutcome": "wound healing measured by wound area, reepithelialization, collagen deposition, and wound contraction", "result": "honey-treated wounds healed faster at first but then re-expanded and showed delayed reepithelialization, collagen deposition, and contraction compared with dressing alone", "resultDirection": "harm", "quality": "low", "qualityWhy": "this is a small animal experiment without a reported sample size, so it gives weak evidence for humans", "directness": "indirect", "limitations": "animal (mouse) model, number of animals not stated, and tests Japanese honeys (acacia, buckwheat, Chinese milk vetch) rather than manuka honey or anorectal surgical wounds", "followUp": "14 days", "plainFinding": "Slower healing than dressing alone.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27852015/", "sourceText": "INTRODUCTION: The aim of this study was to investigate the effects of changing the application of Japanese honey to a hydrocolloid dressing (HCD) in between the inflammatory and proliferative phases on cutaneous wound healing in 8-week-old, BALB/cCrSlc male mice. MATERIALS AND METHODS: Mice were divided into 4 groups: acacia honey followed by a HCD, buckwheat flour honey followed by a HCD, Chinese milk vetch honey followed by a HCD, and a HCD alone (control group). All mice received 2 full-thickness wounds on both sides of the dorsum using a Disposable Biopsy Punch. The wounds of the control group were covered with a HCD, whereas wounds in the other groups were treated with 0.1 mL of the relevant type of honey until day 3 post-wound and then were covered with a HCD from days 4 to 14. RESULTS: In the experimental groups, the wound area ratio was significantly smaller in the inflammatory phase but significantly larger in the proliferative phase. Reepithelialization, collagen deposition, and wound contraction were significantly delayed compared with those in the control group. DISCUSSION: The re-expansion of the wounds in the proliferative phase could not be prevented, and reepithelialization, collagen deposition, and wound contraction were delayed compared with those upon the use of a HCD. CONCLUSION: The study's authors concluded that these methods do not promote cutaneous wound healing better than the use of a HCD alone.", "provenance": [ { "field": "population", "quote": "cutaneous wound healing in 8-week-old, BALB/cCrSlc male mice" }, { "field": "intervention", "quote": "treated with 0.1 mL of the relevant type of honey until day 3 post-wound and then were covered with a HCD from days 4 to 14" }, { "field": "comparator", "quote": "The wounds of the control group were covered with a HCD" }, { "field": "primaryOutcome", "quote": "Reepithelialization, collagen deposition, and wound contraction" }, { "field": "result", "quote": "the wound area ratio was significantly smaller in the inflammatory phase but significantly larger in the proliferative phase. Reepithelialization, collagen deposition, and wound contraction were significantly delayed compared with those in the control group." }, { "field": "result", "quote": "these methods do not promote cutaneous wound healing better than the use of a HCD alone" } ] }, { "id": "pmid:27684356", "pmid": "27684356", "doi": "10.1097/WON.0000000000000273", "nctId": null, "pmcid": "PMC5098468", "title": "A Comprehensive Review of Topical Odor-Controlling Treatment Options for Chronic Wounds", "firstAuthor": "Akhmetova", "multipleAuthors": true, "journal": "J Wound Ostomy Continence Nurs", "year": 2016, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with chronic wounds", "intervention": "topical agents including honey, silver, iodine, sugar, and essential oils for odor control", "comparator": "", "primaryOutcome": "wound odor control and underlying bacterial infection", "result": "not specific to honey or anorectal surgery; general review of odor-control options including honey", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general narrative review about wound odor control, not a study testing manuka honey for healing or anorectal surgery, so it gives no direct evidence on the question.", "directness": "indirect", "limitations": "abstract does not describe study methodology, does not focus on manuka honey specifically, and does not address anorectal surgery or wound healing outcomes directly.", "followUp": "", "plainFinding": "Not studied here directly.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27684356/", "sourceText": "The process of wound healing is often accompanied by bacterial infection or critical colonization, resulting in protracted inflammation, delayed reepithelization, and production of pungent odors. The malodor produced by these wounds may lower health-related quality of life and produce psychological discomfort and social isolation. Current management focuses on reducing bacterial activity within the wound site and absorbing malodorous gases. For example, charcoal-based materials have been incorporated into dressing for direct adsorption of the responsible gases. In addition, multiple topical agents, including silver, iodine, honey, sugar, and essential oils, have been suggested for incorporation into dressings in an attempt to control the underlying bacterial infection. This review describes options for controlling malodor in chronic wounds, the benefits and drawbacks of each topical agent, and their mode of action. We also discuss the use of subjective odor evaluation techniques to assess the efficacy of odor-controlling therapies. The perspectives of employing novel biomaterials and technologies for wound odor management are also presented.", "provenance": [ { "field": "population", "quote": "The process of wound healing is often accompanied by bacterial infection or critical colonization" }, { "field": "intervention", "quote": "multiple topical agents, including silver, iodine, honey, sugar, and essential oils, have been suggested for incorporation into dressings in an attempt to control the underlying bacterial infection" }, { "field": "primaryOutcome", "quote": "Current management focuses on reducing bacterial activity within the wound site and absorbing malodorous gases" }, { "field": "result", "quote": "This review describes options for controlling malodor in chronic wounds, the benefits and drawbacks of each topical agent, and their mode of action." } ] }, { "id": "pmid:27621626", "pmid": "27621626", "doi": "10.2147/IJN.S112265", "nctId": null, "pmcid": "PMC5015880", "title": "Fabrication and hemocompatibility assessment of novel polyurethane-based bio-nanofibrous dressing loaded with honey and Carica papaya extract for the management of burn injuries", "firstAuthor": "Balaji", "multipleAuthors": true, "journal": "Int J Nanomedicine", "year": 2016, "design": "lab", "n": null, "nField": "not-reported", "population": "no human or animal subjects; laboratory material testing for burn wound dressings", "intervention": "a new nanofiber wound dressing material made with polyurethane, honey, and papaya extract", "comparator": "plain polyurethane dressing without honey/papaya", "primaryOutcome": "physical and chemical properties of the dressing material, including water absorption and blood compatibility", "result": "the honey-papaya dressing showed increased water absorption, better wettability, and was non-toxic and compatible with blood in lab tests", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this was only a laboratory material science test of a dressing, not a study on real wounds or patients.", "directness": "indirect", "limitations": "no human or animal wound healing was tested; this only examined material properties and blood compatibility in the lab.", "followUp": "", "plainFinding": "Lab dressing material, not tested on wounds.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27621626/", "sourceText": "Management of burn injury is an onerous clinical task since it requires continuous monitoring and extensive usage of specialized facilities. Despite rapid improvizations and investments in burn management, >30% of victims hospitalized each year face severe morbidity and mortality. Excessive loss of body fluids, accumulation of exudate, and the development of septic shock are reported to be the main reasons for morbidity in burn victims. To assist burn wound management, a novel polyurethane (PU)-based bio-nanofibrous dressing loaded with honey (HN) and Carica papaya (PA) fruit extract was fabricated using a one-step electrospinning technique. The developed dressing material had a mean fiber diameter of 190±19.93 nm with pore sizes of 4-50 µm to support effective infiltration of nutrients and gas exchange. The successful blending of HN- and PA-based active biomolecules in PU was inferred through changes in surface chemistry. The blend subsequently increased the wettability (14%) and surface energy (24%) of the novel dressing. Ultimately, the presence of hydrophilic biomolecules and high porosity enhanced the water absorption ability of the PU-HN-PA nanofiber samples to 761.67% from 285.13% in PU. Furthermore, the ability of the bio-nanofibrous dressing to support specific protein adsorption (45%), delay thrombus formation, and reduce hemolysis demonstrated its nontoxic and compatible nature with the host tissues. In summary, the excellent physicochemical and hemocompatible properties of the developed PU-HN-PA dressing exhibit its potential in reducing the clinical complications associated with the treatment of burn injuries.", "provenance": [ { "field": "population", "quote": "To assist burn wound management, a novel polyurethane (PU)-based bio-nanofibrous dressing loaded with honey (HN) and Carica papaya (PA) fruit extract was fabricated using a one-step electrospinning technique." }, { "field": "intervention", "quote": "polyurethane (PU)-based bio-nanofibrous dressing loaded with honey (HN) and Carica papaya (PA) fruit extract" }, { "field": "comparator", "quote": "the water absorption ability of the PU-HN-PA nanofiber samples to 761.67% from 285.13% in PU" }, { "field": "primaryOutcome", "quote": "the ability of the bio-nanofibrous dressing to support specific protein adsorption (45%), delay thrombus formation, and reduce hemolysis demonstrated its nontoxic and compatible nature with the host tissues" }, { "field": "result", "quote": "the excellent physicochemical and hemocompatible properties of the developed PU-HN-PA dressing exhibit its potential in reducing the clinical complications associated with the treatment of burn injuries" } ] }, { "id": "pmid:27611017", "pmid": "27611017", "doi": "10.1097/ANC.0000000000000331", "nctId": null, "pmcid": null, "title": "Leptospermum Honey for Wound Care in an Extremely Premature Infant", "firstAuthor": "Esser", "multipleAuthors": false, "journal": "Adv Neonatal Care", "year": 2017, "design": "case-series", "n": null, "nField": "not-reported", "population": "a premature newborn (23 weeks gestation) with a severe skin wound", "intervention": "Leptospermum (manuka) honey dressing", "comparator": "hydrogel dressing used first, before switching to honey", "primaryOutcome": "wound healing time, scarring, and limb function", "result": "quick healing, little to no scarring, no loss of movement or function", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether honey generally works.", "directness": "indirect", "limitations": "single case with no comparison group; abstract notes evidence is lacking in neonates and calls for more research", "followUp": "", "plainFinding": "Faster healing, less scarring in one infant", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27611017/", "sourceText": "BACKGROUND/INTRODUCTION TO CASE: Neonatal wound care is challenging due to the fragility and vulnerable skin structure. Neonates are often left susceptible to the forces of their environment, leaving them open to infection when skin injury occurs. Leptospermum honey has been used successfully in adult patients, with evidence lacking in the neonatal population. This case demonstrates the management of a difficult-to-heal wound in a 23-week gestation infant. PURPOSE: Selecting the proper treatment and products for wound healing is challenging, with little evidence-based research available for the treatment of neonatal wounds. Leptospermum honey and other adult-driven dressings have been used for neonatal wound care as well as other adult-driven dressings. This case demonstrates the benefits of Leptospermum honey as an option for neonatal wounds. CASE FINDINGS/RESULTS: This case presents the treatment and healing of an extensive wound of a 23-week gestation neonate using a hydrogel product initially and then transitioning to a Leptospermum honey dressing due to suboptimal healing. Results of this treatment included quick healing time, little to no scarring, and no loss of movement or function to the affected extremities. IMPLICATIONS FOR PRACTICE: The incorporation of Leptospermum honey for wound care has the potential to promote faster wound healing, with less scarring in the neonatal population. IMPLICATIONS FOR RESEARCH: Adult wound care principles have been applied in the face of a weak evidence base relating to neonatal-specific cases. There is a need for continued research related to moist wound healing in the neonatal population, with resulting product and practice recommendations.", "provenance": [ { "field": "n", "quote": "a 23-week gestation infant" }, { "field": "population", "quote": "the management of a difficult-to-heal wound in a 23-week gestation infant" }, { "field": "intervention", "quote": "transitioning to a Leptospermum honey dressing due to suboptimal healing" }, { "field": "comparator", "quote": "using a hydrogel product initially and then transitioning to a Leptospermum honey dressing" }, { "field": "primaryOutcome", "quote": "Results of this treatment included quick healing time, little to no scarring, and no loss of movement or function to the affected extremities." }, { "field": "result", "quote": "quick healing time, little to no scarring, and no loss of movement or function to the affected extremities" }, { "field": "limitations", "quote": "with evidence lacking in the neonatal population" } ] }, { "id": "pmid:27576926", "pmid": "27576926", "doi": "10.1016/j.burns.2016.07.004", "nctId": null, "pmcid": null, "title": "The effects of honey compared to silver sulfadiazine for the treatment of burns: A systematic review of randomized controlled trials", "firstAuthor": "Aziz", "multipleAuthors": true, "journal": "Burns", "year": 2017, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people with burn wounds", "intervention": "honey dressings", "comparator": "silver sulfadiazine dressings", "primaryOutcome": "time for wound to heal and number of infected wounds becoming sterile", "result": "honey healed wounds faster and cleared more infections than silver sulfadiazine", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "Based on nine randomized trials rated as moderate quality evidence, but this is about burns, not anorectal surgery wounds.", "directness": "indirect", "limitations": "Abstract does not report study sizes, blinding details, or heterogeneity; honey type not specified as manuka.", "followUp": "", "plainFinding": "Faster healing, more infections cleared.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27576926/", "sourceText": "Evidence from animal studies and trials suggests that honey may accelerate wound healing. The objective of this review was to assess the effects of honey compared with silver dressings on the healing of burn wounds. Relevant databases for randomized controlled trials (RCTs) of honey compared with silver sulfadiazine (SSD) were searched. The quality of the selected trials was assessed using the Cochrane Risk of Bias Assessment Tool. The primary endpoints considered were wound healing time and the number of infected wounds rendered sterile. Nine RCTs met the inclusion criteria. Based on moderate quality evidence there was a statistically significant difference between the two groups, favoring honey in healing time (MD -5.76days, 95% CI -8.14 to -3.39) and the proportions of infected wounds rendered sterile (RR 2.59; 95% CI 1.58-2.88). The available evidence suggests that honey dressings promote better wound healing than silver sulfadiazine for burns.", "provenance": [ { "field": "population", "quote": "honey compared with silver dressings on the healing of burn wounds" }, { "field": "intervention", "quote": "honey dressings" }, { "field": "comparator", "quote": "silver sulfadiazine (SSD)" }, { "field": "primaryOutcome", "quote": "The primary endpoints considered were wound healing time and the number of infected wounds rendered sterile." }, { "field": "result", "quote": "there was a statistically significant difference between the two groups, favoring honey in healing time (MD -5.76days, 95% CI -8.14 to -3.39) and the proportions of infected wounds rendered sterile (RR 2.59; 95% CI 1.58-2.88)" } ] }, { "id": "pmid:27502813", "pmid": "27502813", "doi": "10.1016/j.ctcp.2016.06.003", "nctId": null, "pmcid": null, "title": "Topical honey for the treatment of diabetic foot ulcer: A systematic review", "firstAuthor": "Kateel", "multipleAuthors": true, "journal": "Complement Ther Clin Pract", "year": 2016, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people with diabetic foot ulcers", "intervention": "topical honey dressing", "comparator": "conventional wound dressing", "primaryOutcome": "wound healing and safety of honey treatment", "result": "Review found honey dressing was safe, and three of five clinical trials found it worked better than conventional dressing, but overall evidence was not strong enough to judge effectiveness", "resultDirection": "unclear", "quality": "low", "qualityWhy": "Based on only five small clinical trials and observational studies with no pooled statistical analysis, and the authors themselves say the data quality is insufficient to judge efficacy.", "directness": "indirect", "limitations": "Insufficient good quality data to conclude on efficacy; relies partly on observational studies where efficacy cannot be assessed.", "followUp": "", "plainFinding": "Safe, but benefit unproven.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27502813/", "sourceText": "Topical honey has been used for the treatment of wound since ancient time. But the medical evidence proving it is limited. Hence a systematic review was planned. An exhaustive literature search was done in PUBMED, COCHRANE, GOOGLE using 'topical honey', 'diabetic foot ulcer', 'chronic wounds' as key words. Literature search showed total of five clinical trials and about ten observational studies in various part of world. Out of five clinical trials three concluded that honey dressing is better than conventional dressing, all the clinical trials proved safety of honey for the treatment of diabetic foot ulcer. Observational studies included total of 320 patients which also showed safety of honey but efficacy cannot be considered from observational studies. This review showed that honey dressing is safer for treatment of diabetic foot ulcer but there is insufficient good quality data to realistically conclude on the efficacy of honey on diabetic foot ulcers.", "provenance": [ { "field": "population", "quote": "treatment of diabetic foot ulcer" }, { "field": "intervention", "quote": "Topical honey has been used for the treatment of wound" }, { "field": "comparator", "quote": "honey dressing is better than conventional dressing" }, { "field": "primaryOutcome", "quote": "showed safety of honey but efficacy cannot be considered from observational studies" }, { "field": "result", "quote": "there is insufficient good quality data to realistically conclude on the efficacy of honey on diabetic foot ulcers" }, { "field": "n", "quote": "Observational studies included total of 320 patients" } ] }, { "id": "pmid:27429228", "pmid": "27429228", "doi": "10.1097/IOP.0000000000000743", "nctId": null, "pmcid": null, "title": "Effect of Manuka Honey on Eyelid Wound Healing: A Randomized Controlled Trial", "firstAuthor": "Malhotra", "multipleAuthors": true, "journal": "Ophthalmic Plast Reconstr Surg", "year": 2017, "design": "rct", "n": 46, "nField": "reported", "population": "adults having upper eyelid cosmetic surgery (blepharoplasty)", "intervention": "Manuka honey applied to one eyelid wound twice daily plus Vaseline", "comparator": "Vaseline alone on the other eyelid wound", "primaryOutcome": "scar appearance and patient-reported wound symptoms over time", "result": "No significant difference in scar grading scales at any time point, though patients reported less scar pain and stiffness on the honey-treated side", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It was a randomized, single-blinded trial with each patient acting as their own control, but it was small and looked at eyelid skin, not anorectal wounds.", "directness": "indirect", "limitations": "Small sample size after dropouts, single-blinded design, and results are specific to eyelid surgical wounds rather than anorectal wounds.", "followUp": "4 months", "plainFinding": "No difference in scars; less reported pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27429228/", "sourceText": "PURPOSE: To report outcomes of a randomized trial on the role of \"active\" Manuka honey on eyelid surgical wound healing. METHOD: Prospective, randomized, single-blinded study was performed for patients undergoing bilateral upper blepharoplasty. Vaseline was applied 4 times a day to both sides for 6 weeks and in addition, one eyelid was randomized to receive Manuka honey twice daily. Postoperative wounds were graded by a masked observer at 1 week, 1 month, and 4 months using Manchester scar scale and a modified eyelid scar grading scale. Patients scored symptoms, expressed preferred side, and of any problems they experienced using honey. Standard photographs were graded by 2 independent assessors. RESULTS: Fifty-five patients were randomized. One week after surgery, 46 (29 women, 17 men, mean age 68 years, median 69, range 49-85) were available for analysis. There was a trend toward distortion of the surrounding skin being less (1.6 vs. 1.8, p = 0.07) and the scar being less palpable (1.8 vs. 2.0, p = 0.08) on the Manuka-treated side. Patients reported the scar on the Manuka side to have less stiffness (1.3 vs. 1.6, p = 0.058). At 1 month, all 3 grading scales showed no difference between the 2 sides. At 4 months, scar grading scales showed no differences; however, patients reported scar pain to be significantly less on the Manuka-treated side than control (0.48 vs. 1.9, p = 0.005). Thirty-one of 46 patients believed the scars were similar on both sides, 11 preferred the honey-treated side, and 4 preferred the control. CONCLUSION: Upper eyelid scars treated with or without Manuka honey heal well, without significant difference when assessed by validated scar grading scales; however, honey may provide subjective benefits early, postoperatively.", "provenance": [ { "field": "population", "quote": "patients undergoing bilateral upper blepharoplasty" }, { "field": "intervention", "quote": "one eyelid was randomized to receive Manuka honey twice daily" }, { "field": "comparator", "quote": "Vaseline was applied 4 times a day to both sides for 6 weeks" }, { "field": "primaryOutcome", "quote": "Postoperative wounds were graded by a masked observer at 1 week, 1 month, and 4 months using Manchester scar scale and a modified eyelid scar grading scale." }, { "field": "result", "quote": "At 1 month, all 3 grading scales showed no difference between the 2 sides. At 4 months, scar grading scales showed no differences; however, patients reported scar pain to be significantly less on the Manuka-treated side than control (0.48 vs. 1.9, p = 0.005)." }, { "field": "n", "quote": "46 (29 women, 17 men, mean age 68 years, median 69, range 49-85) were available for analysis" } ] }, { "id": "pmid:27050177", "pmid": "27050177", "doi": null, "nctId": null, "pmcid": null, "title": "Honey on oral mucositis: A Randomized controlled trial", "firstAuthor": "Jayalekshmi", "multipleAuthors": true, "journal": "Gulf J Oncolog", "year": 2016, "design": "rct", "n": 28, "nField": "reported", "population": "head and neck cancer patients undergoing radiation therapy", "intervention": "natural honey applied to the mouth", "comparator": "plain water applied to the mouth", "primaryOutcome": "severity of radiation-induced mouth sores (oral mucositis)", "result": "Honey group had less severe mouth sores than water group, especially in weeks 4-6", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Very small study with only 28 patients and single-blinding, so results could be due to chance or bias.", "directness": "indirect", "limitations": "Small sample size, single-blind design, not studying surgical wounds or manuka honey specifically.", "followUp": "6 weeks", "plainFinding": "Less severe mouth sores with honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27050177/", "sourceText": "BACKGROUND AND OBJECTIVE: The main stream of management of head and neck cancer is by radiotherapy and surgery. During radiation therapy in head and neck cancers, oral cavity is directly exposed to high dose radiation which leads to several side effects - oral mucositis being the most distressing one. This study was intended to assess the effects of applying honey on oral mucositis during radiation therapy. MATERIAL AND METHODS: The research design used in this study was Randomized Control Trial with single blinding method in the Radiotherapy Unit of Regional Cancer Centre (RCC), at JIPMER. The study population included a total of 28 patients. Participants in experimental group were given 15ml natural honey for applying on oral mucosa and in control group 15ml plain water were given. Assessment of oral mucosa was done after every 5 doses of radiation therapy using RTOG scale and severity of oral mucositis was assessed. RESULTS: There was a statistically significant difference in degree of oral mucositis between the experimental and control group in week 4, 5 and 6 (p<0.01). During the whole course of study, 9 (64.28 percent) participants in control group developed grade III oral mucositis while only one participant (7.14%) in experimental group developed grade III oral mucositis. CONCLUSION: The study concluded that applying natural honey on oral mucositis was effective among head and neck cancers patients receiving external beam radiation therapy.", "provenance": [ { "field": "population", "quote": "The study population included a total of 28 patients." }, { "field": "intervention", "quote": "Participants in experimental group were given 15ml natural honey for applying on oral mucosa" }, { "field": "comparator", "quote": "in control group 15ml plain water were given" }, { "field": "primaryOutcome", "quote": "severity of oral mucositis was assessed" }, { "field": "result", "quote": "There was a statistically significant difference in degree of oral mucositis between the experimental and control group in week 4, 5 and 6 (p<0.01). During the whole course of study, 9 (64.28 percent) participants in control group developed grade III oral mucositis while only one participant (7.14%) in experimental group developed grade III oral mucositis." }, { "field": "n", "quote": "The study population included a total of 28 patients." } ] }, { "id": "pmid:27027667", "pmid": "27027667", "doi": "10.1080/10376178.2016.1171727", "nctId": null, "pmcid": null, "title": "A systematic review and meta-analysis of dressings used for wound healing: the efficiency of honey compared to silver on burns", "firstAuthor": "Lindberg", "multipleAuthors": true, "journal": "Contemp Nurse", "year": 2015, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people with burn wounds, mostly from studies conducted in South Asia", "intervention": "honey dressings applied to wounds", "comparator": "silver dressings applied to wounds", "primaryOutcome": "how many days it took for wounds to heal", "result": "honey healed wounds faster than silver and had more antibacterial effect", "resultDirection": "benefit", "quality": "low", "qualityWhy": "only six pooled trials from one region, no detail on honey type, bias, or wound severity, and burns are not the same as anorectal surgical wounds.", "directness": "indirect", "limitations": "Only six randomised trials included, all from South Asia, abstract gives no detail on trial quality, blinding, or dropout, and the honey type used is not specified as manuka.", "followUp": "", "plainFinding": "Honey healed burns faster than silver.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27027667/", "sourceText": "BACKGROUND: Honey has the antibacterial effect of silver without the toxic effect of silver on the skin. Even so, silver is the dominant antibacterial dressing used in wound healing. OBJECTIVES: To evaluate the healing effects of honey dressings compared to silver dressings for acute or chronic wounds. DESIGN: A systematic review with meta-analysis. METHOD: The search, conducted in seven databases, resulted in six randomised controlled trial studies from South Asia focusing on antibacterial properties and healing times of honey and silver. RESULT: Honey was more efficacious for wound healing than silver, as measured in the number of days needed for wounds to heal (pooled risk difference -20, 95% CI -0.29 to -0.11, p < .001). Honey turned out to have more antibacterial qualities than silver. CONCLUSION: All the included studies based on burns showed the unequivocal result that honey had an even more positive effect than silver on wound healing.", "provenance": [ { "field": "population", "quote": "six randomised controlled trial studies from South Asia focusing on antibacterial properties and healing times of honey and silver" }, { "field": "intervention", "quote": "honey dressings" }, { "field": "comparator", "quote": "silver dressings" }, { "field": "primaryOutcome", "quote": "the number of days needed for wounds to heal" }, { "field": "result", "quote": "Honey was more efficacious for wound healing than silver, as measured in the number of days needed for wounds to heal (pooled risk difference -20, 95% CI -0.29 to -0.11, p < .001)" }, { "field": "result", "quote": "All the included studies based on burns showed the unequivocal result that honey had an even more positive effect than silver on wound healing." } ] }, { "id": "pmid:26977860", "pmid": "26977860", "doi": "10.1159/000441994", "nctId": null, "pmcid": null, "title": "Topical Application of Honey on Surgical Wounds: A Randomized Clinical Trial", "firstAuthor": "Goharshenasan", "multipleAuthors": true, "journal": "Forsch Komplementmed", "year": 2016, "design": "rct", "n": 52, "nField": "reported", "population": "patients having plastic surgery with bilateral symmetric incisions", "intervention": "honey dressing on surgical wound", "comparator": "conventional dressing on surgical wound", "primaryOutcome": "appearance/width of the scar", "result": "honey-dressed side had narrower scars than conventional dressing side at 3 and 6 months", "resultDirection": "benefit", "quality": "low", "qualityWhy": "small single trial using a cosmetic scar measure rather than overall wound healing or infection outcomes, and it's not clear honey type was manuka.", "directness": "indirect", "limitations": "Small number of patients, used scar width/appearance rather than broader healing outcomes, not specifically anorectal surgery or manuka honey.", "followUp": "6 months", "plainFinding": "Smaller, less visible scars with honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26977860/", "sourceText": "BACKGROUND: The antimicrobial and anti-inflammatory activity of honey and its ability to accelerate wound healing make it an attractive option in surgical wound care. We performed a randomized clinical trial to compare the efficacy of honey dressing with conventional dressing regarding the aesthetic outcome. PATIENTS AND METHODS: Bilateral symmetric incisions in randomly selected plastic surgical patients were randomly covered postoperatively with conventional dressing and honey dressing for five days. The aesthetic outcome of the two sides was rated on a Visual Analog Scale by the surgeon and the patient and compared at month three and six after surgery. RESULTS: Seventy two symmetrical incisions in 52 patients were evaluated during the study. The mean width of the scar after the third and the sixth month was 3.64 +/- 0.83 mm and 3.49 +/- 0.87 mm on the side that received honey dressing and 5.43 +/- 0.05 mm and 5.30+/- 1.35 mm in the control group. Wilcoxon signed-rank test showed significant difference between honey and conventional dressing outcomes at third and sixth month (p < 0.001). CONCLUSION: The healing process of the surgical wound and its final aesthetic result could be improved by using honey dressing.", "provenance": [ { "field": "n", "quote": "Seventy two symmetrical incisions in 52 patients were evaluated during the study." }, { "field": "population", "quote": "randomly selected plastic surgical patients" }, { "field": "intervention", "quote": "honey dressing" }, { "field": "comparator", "quote": "conventional dressing" }, { "field": "primaryOutcome", "quote": "The aesthetic outcome of the two sides was rated on a Visual Analog Scale by the surgeon and the patient and compared at month three and six after surgery." }, { "field": "result", "quote": "The mean width of the scar after the third and the sixth month was 3.64 +/- 0.83 mm and 3.49 +/- 0.87 mm on the side that received honey dressing and 5.43 +/- 0.05 mm and 5.30+/- 1.35 mm in the control group." } ] }, { "id": "pmid:26878302", "pmid": "26878302", "doi": "10.12968/jowc.2016.25.2.93", "nctId": null, "pmcid": null, "title": "In vitro activity of an engineered honey, medical-grade honeys, and antimicrobial wound dressings against biofilm-producing clinical bacterial isolates", "firstAuthor": "Halstead", "multipleAuthors": true, "journal": "J Wound Care", "year": 2016, "design": "lab", "n": 16, "nField": "reported", "population": "bacterial isolates that form biofilms (in vitro, not patients)", "intervention": "engineered honey (Surgihoney RO) and medical-grade manuka honeys", "comparator": "antimicrobial wound dressings containing honey, and untreated controls", "primaryOutcome": "ability to prevent bacterial biofilm formation in lab dishes", "result": "engineered honey was most potent at stopping biofilm formation, working at lower dilutions than manuka honeys for some isolates and equal for others, and beat honey-containing dressings", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a lab dish test on bacteria, not a study of people or wounds healing, so it cannot show whether honey helps patients.", "directness": "indirect", "limitations": "In vitro testing only on bacterial isolates; no patients, wounds, or clinical healing outcomes were studied; funder provided one product free of charge.", "followUp": "", "plainFinding": "Stops bacterial biofilms in lab tests.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26878302/", "sourceText": "OBJECTIVE: Honey is recognised to be a good topical wound care agent owing to a broad-spectrum of antimicrobial activity combined with healing properties. Surgihoney RO (SH1) is a product based on honey that is engineered to produce enhanced reactive oxygen species (ROS) and has been reported to be highly antimicrobial. The objective was to investigate the ability of the engineered honey and its comparators to prevent biofilm formation in vitro. METHOD: We tested the ability of three medical-grade honeys SH1, Activon manuka honey (MH) and Medihoney manuka honey (Med), alongside five antimicrobial dressings (AMDs) to prevent the formation of biofilms by 16 isolates. Honeys were serially double diluted from 1:3 down to 1:6144 and the lowest dilution achieving a statistically significant reduction in biomass of at least 50%, compared with untreated controls, was recorded. RESULTS: Although all the honeys were antibacterial and were able to prevent the formation of biofilms, SH1 was the most potent, with efficacy at lower dilutions than the medical honeys for five isolates, and equivalent dilutions for a further six. Additionally, SH1 was superior in antibacterial potency to three commercially available AMDs that contain honey. CONCLUSION: SH1 is effective at preventing bioflms from forming and is superior to medical honeys and AMDs in in vitro tests. DECLARATION OF INTEREST: Surgihoney RO was provided free of charge for testing by Matoke Holdings, UK and the hospital pharmacy provided the other honeys and dressings. This paper presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.", "provenance": [ { "field": "population", "quote": "to prevent the formation of biofilms by 16 isolates" }, { "field": "intervention", "quote": "three medical-grade honeys SH1, Activon manuka honey (MH) and Medihoney manuka honey (Med)" }, { "field": "comparator", "quote": "five antimicrobial dressings (AMDs)" }, { "field": "primaryOutcome", "quote": "investigate the ability of the engineered honey and its comparators to prevent biofilm formation in vitro" }, { "field": "result", "quote": "SH1 was the most potent, with efficacy at lower dilutions than the medical honeys for five isolates, and equivalent dilutions for a further six" }, { "field": "n", "quote": "by 16 isolates" } ] }, { "id": "pmid:26803744", "pmid": "26803744", "doi": "10.1186/s12906-016-1003-6", "nctId": null, "pmcid": "PMC4724403", "title": "Effect of Tualang honey on the anastomotic wound healing in large bowel anastomosis in rats-A randomized controlled trial", "firstAuthor": "Aznan", "multipleAuthors": true, "journal": "BMC Complement Altern Med", "year": 2016, "design": "animal", "n": 30, "nField": "reported", "population": "Wistar rats with surgically created bowel connections (anastomosis)", "intervention": "Oral Tualang honey (1.0 g/kg daily for 7 days after surgery)", "comparator": "Standard rat chow and water only", "primaryOutcome": "Strength and healing quality of the surgical bowel connection", "result": "Honey-treated rats had significantly stronger anastomosis and better healing markers (more fibroblasts, fewer inflammatory cells); no significant difference in new blood vessel formation", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a small animal study, so it cannot reliably predict what happens in human patients.", "directness": "indirect", "limitations": "Small sample size (30 rats), animal model not human, and honey type (Tualang, not manuka) and administration (oral, not topical wound application) differ from the question being asked.", "followUp": "7 days", "plainFinding": "Stronger gut healing in rats.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26803744/", "sourceText": "BACKGROUND: Honey has long been used for the treatment of number of ailments and diseases including surgical wounds. Current study evaluates the effectiveness of Tualang honey (TH) for large bowel anastomotic healing in Wistar rats. METHODS: Thirty male Wistar rats were given a 3 centimeter infra-umbilical laparotomy wound, in`flicted on their abdomen. The colonic transection was performed at 5 cm distal to caecum, with end to end anastomosis of colon segment. They were divided into two groups. Group I was fed with standard rat chow and water. Meanwhile, Group II apart from standard feed, was also given TH 1.0 g/kg every morning until day seven post operatively. Afterwards, anastomotic bursting pressures were measured and histopathological examination on the anastomosis line was performed with light microscopes. The data from two groups were analyzed by Independent paired t test for continuous variables. RESULTS: It was found that the tensile strength of colon anastomosis (95 % CI; p = <0.001) and the histopathological study including fibroblast count (p = <0.001) and inflammatory cells (p = 0.002) showed statistically significant difference in the favor of TH-treated group. Meanwhile, neovascularization formation was not statistically significant (p = 0.807); however, the overall count in the TH group was high. CONCLUSION: Oral treatment with TH enhances anastomotic wound healing by increasing the number of fibroblasts and by decreasing inflammatory cells leading towards increased wound strength.", "provenance": [ { "field": "population", "quote": "Thirty male Wistar rats were given a 3 centimeter infra-umbilical laparotomy wound" }, { "field": "intervention", "quote": "TH 1.0 g/kg every morning until day seven post operatively" }, { "field": "comparator", "quote": "Group I was fed with standard rat chow and water" }, { "field": "primaryOutcome", "quote": "anastomotic bursting pressures were measured and histopathological examination on the anastomosis line was performed" }, { "field": "result", "quote": "the tensile strength of colon anastomosis (95 % CI; p = <0.001) and the histopathological study including fibroblast count (p = <0.001) and inflammatory cells (p = 0.002) showed statistically significant difference in the favor of TH-treated group" }, { "field": "n", "quote": "Thirty male Wistar rats" } ] }, { "id": "pmid:26773204", "pmid": "26773204", "doi": "10.1016/j.ijscr.2015.12.051", "nctId": null, "pmcid": "PMC4818303", "title": "Post-bariatric abdominoplasty resulting in wound infection and dehiscence-Conservative treatment with medical grade honey: A case report and review of literature", "firstAuthor": "Dina Jarjis", "multipleAuthors": true, "journal": "Int J Surg Case Rep", "year": 2016, "design": "case-series", "n": 1, "nField": "reported", "population": "A 40-year-old woman with a wound infection and wound separation after a tummy tuck following massive weight loss", "intervention": "Topical Manuka honey applied to the wound", "comparator": "No comparison group (single case)", "primaryOutcome": "Wound healing and clinical improvement", "result": "The wound healed well with good improvement and patient satisfaction", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether honey generally works for wound healing.", "directness": "indirect", "limitations": "Single case report, no comparison group, not anorectal surgery, author states more research is needed", "followUp": "", "plainFinding": "Wound healed well with honey", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26773204/", "sourceText": "INTRODUCTION: Wound complications in post-bariatric patients undergoing body-contouring surgery after massive weight loss are not uncommon and often, surgical debridement or conservative management is necessary. Honey is one of the most ancient remedies for wound care and it is also considered to possess debriding effects. Current research has demonstrated promising results showing that honey can improve wound granulation and epithelialization, reduce exudate and shorten healing times. METHODS: This case report has been reported in line with the CARE criteria. PRESENTATION OF CASE: A 40 year-old female suffered wound infection and dehiscence after undergoing post-bariatric abdominoplasty. The patient was not interested in surgical revision and split skin grafting. Therefore, conservative wound treatment with topical Manuka honey was instituted resulting in significant clinical improvement and effective healing concurrently with good patient satisfaction. DISCUSSION: Surgical wound complications in post-bariatric patients undergoing abdominoplasty are common and often require surgical revision or conservative wound treatment. No previous publication has addressed outpatient treatment of post-bariatric abdominoplasty wound complications with medical grade honey. CONCLUSION: Although more research is needed for definitive conclusions of honey's efficacy, it is safe and as presented in our case, it may under certain circumstances reduce the need of surgical wound debridement and serve as a remedy for conservative treatment.", "provenance": [ { "field": "n", "quote": "A 40 year-old female suffered wound infection and dehiscence after undergoing post-bariatric abdominoplasty." }, { "field": "population", "quote": "A 40 year-old female suffered wound infection and dehiscence after undergoing post-bariatric abdominoplasty." }, { "field": "intervention", "quote": "conservative wound treatment with topical Manuka honey was instituted" }, { "field": "comparator", "quote": "The patient was not interested in surgical revision and split skin grafting." }, { "field": "primaryOutcome", "quote": "resulting in significant clinical improvement and effective healing concurrently with good patient satisfaction" }, { "field": "result", "quote": "resulting in significant clinical improvement and effective healing concurrently with good patient satisfaction" } ] }, { "id": "pmid:26454386", "pmid": "26454386", "doi": "10.2015/JCPSP.721725", "nctId": null, "pmcid": null, "title": "A Randomized, Controlled Clinical Trial of Honey-Impregnated Dressing for Treating Diabetic Foot Ulcer", "firstAuthor": "Imran", "multipleAuthors": true, "journal": "J Coll Physicians Surg Pak", "year": 2015, "design": "rct", "n": 348, "nField": "reported", "population": "patients with diabetic foot ulcers (grade 1 and 2)", "intervention": "honey-impregnated wound dressing", "comparator": "normal saline dressing", "primaryOutcome": "proportion of wounds completely healed", "result": "more wounds fully healed and faster healing with honey dressing than saline", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial with a reasonably large number of patients, but it used a different type of honey (Beri-honey) on diabetic foot ulcers, not manuka honey or anorectal surgery wounds.", "directness": "indirect", "limitations": "Abstract does not report blinding, allocation concealment, or dropout details.", "followUp": "120 days", "plainFinding": "Faster, more complete wound healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26454386/", "sourceText": "OBJECTIVE: To investigate the effect of Beri-honey-impregnated dressing on diabetic foot ulcer and compare it with normal saline dressing. STUDY DESIGN: A randomized, controlled trial. PLACE AND DURATION OF STUDY: Sughra Shafi Medical Complex, Narowal, Pakistan and Bhatti International Trust (BIT) Hospital, Affiliated with Central Park Medical College, Lahore, from February 2006 to February 2010. METHODOLOGY: Patients with Wagner's grade 1 and 2 ulcers were enrolled. Those patients were divided in two groups; group A (n=179) treated with honey dressing and group B (n=169) treated with normal saline dressing. Outcome measures were calculated in terms of proportion of wounds completely healed (primary outcome), wound healing time, and deterioration of wounds. Patients were followed-up for a maximum of 120 days. RESULTS: One hundred and thirty six wounds (75.97%) out of 179 were completely healed with honey dressing and 97 (57.39%) out of 169 wtih saline dressing (p=0.001). The median wound healing time was 18.00 (6 - 120) days (Median with IQR) in group A and 29.00 (7 - 120) days (Median with IQR) in group B (p < 0.001). CONCLUSION: The present results showed that honey is an effective dressing agent instead of conventional dressings, in treating patients of diabetic foot ulcer.", "provenance": [ { "field": "n", "quote": "group A (n=179) treated with honey dressing and group B (n=169) treated with normal saline dressing" }, { "field": "population", "quote": "Patients with Wagner's grade 1 and 2 ulcers were enrolled." }, { "field": "intervention", "quote": "Beri-honey-impregnated dressing on diabetic foot ulcer" }, { "field": "comparator", "quote": "compare it with normal saline dressing" }, { "field": "primaryOutcome", "quote": "proportion of wounds completely healed (primary outcome)" }, { "field": "result", "quote": "One hundred and thirty six wounds (75.97%) out of 179 were completely healed with honey dressing and 97 (57.39%) out of 169 wtih saline dressing (p=0.001)." } ] }, { "id": "pmid:26061489", "pmid": "26061489", "doi": null, "nctId": null, "pmcid": null, "title": "Honey: A Biologic Wound Dressing", "firstAuthor": "Molan", "multipleAuthors": true, "journal": "Wounds", "year": 2015, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with wounds", "intervention": "honey used as a wound dressing (including manuka honey)", "comparator": "not reported", "primaryOutcome": "wound healing process and related biological effects", "result": "The abstract describes mechanisms by which honey, especially manuka honey, promotes wound healing, antibacterial action, immune stimulation, anti-inflammatory effects, and debridement, but reports no specific comparative outcome data", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review explaining mechanisms rather than presenting original comparative trial data, so it cannot establish whether honey improves healing outcomes.", "directness": "indirect", "limitations": "No study design, patient numbers, comparator, or outcome data are reported; it is a mechanistic/narrative review, not a clinical trial.", "followUp": "", "plainFinding": "Explains why honey may help, no data.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26061489/", "sourceText": "Honey has been used as a wound dressing for thousands of years, but only in more recent times has a scientific explanation become available for its effectiveness. It is now realized that honey is a biologic wound dressing with multiple bioactivities that work in concert to expedite the healing process. The physical properties of honey also expedite the healing process: its acidity increases the release of oxygen from hemoglobin thereby making the wound environment less favorable for the activity of destructive proteases, and the high osmolarity of honey draws fluid out of the wound bed to create an outflow of lymph as occurs with negative pressure wound therapy. Honey has a broad-spectrum antibacterial activity, but there is much variation in potency between different honeys. There are 2 types of antibacterial activity. In most honeys the activity is due to hydrogen peroxide, but much of this is inactivated by the enzyme catalase that is present in blood, serum, and wound tissues. In manuka honey, the activity is due to methylglyoxal which is not inactivated. The manuka honey used in wound-care products can withstand dilution with substantial amounts of wound exudate and still maintain enough activity to inhibit the growth of bacteria. There is good evidence for honey also having bioactivities that stimulate the immune response (thus promoting the growth of tissues for wound repair), suppress inflammation, and bring about rapid autolytic debridement. There is clinical evidence for these actions, and research is providing scientific explanations for them.", "provenance": [ { "field": "population", "quote": "Honey has been used as a wound dressing for thousands of years" }, { "field": "intervention", "quote": "In manuka honey, the activity is due to methylglyoxal which is not inactivated." }, { "field": "primaryOutcome", "quote": "it is now realized that honey is a biologic wound dressing with multiple bioactivities that work in concert to expedite the healing process." }, { "field": "result", "quote": "There is good evidence for honey also having bioactivities that stimulate the immune response (thus promoting the growth of tissues for wound repair), suppress inflammation, and bring about rapid autolytic debridement." }, { "field": "comparator", "quote": "There is much variation in potency between different honeys." } ] }, { "id": "pmid:26054992", "pmid": "26054992", "doi": null, "nctId": null, "pmcid": null, "title": "Topical Agents and Dressings for Pilonidal Sinus Wound Healing by Secondary Intention: A Scoping Review", "firstAuthor": "Woo", "multipleAuthors": true, "journal": "Surg Technol Int", "year": 2015, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus wounds healing after surgery (open wound healing)", "intervention": "topical treatments like honey, silver, hydrogel, zinc, foam dressings, negative pressure therapy, platelet rich plasma, and plant extracts", "comparator": "other dressings or standard wound care", "primaryOutcome": "wound healing, bacterial load, and wound pain", "result": "some evidence these treatments may help healing, reduce bacteria, or ease pain, but evidence is weak", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "this is a scoping review of studies with acknowledged methodological limitations and biases, so conclusions are weak.", "directness": "indirect", "limitations": "evidence remains insufficient in light of methodological limitations and biases of the studies", "followUp": "", "plainFinding": "Weak evidence honey may help healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26054992/", "sourceText": "Pilonidal disease (PD) is a chronic and debilitating condition. The overall aim of the scoping review is to map and summarize a wide range of evidence to examine which topical agent or dressing is effective in promoting pilonidal wound healing by secondary intention. Review of this cumulative body of evidence will inform care and guide dressing selection for PD related wounds and delineate future research priorities based on identified knowledge gaps and clinical practice issues. Overall, there is some evidence to suggest that topical applications of hydrogel, silver, honey, zinc, selected foam materials, negative pressure wound therapy, platelet rich plasma, and plant extracts may promote wound healing. Topical treatment using polyhexamethylene biguanide and silver may be beneficial in reducing bacterial burden. Finally, silver, honey, and hydrocolloid dressings may help alleviate wound related pain. However, evidence remains insufficient in light of methodological limitations and biases of the studies.", "provenance": [ { "field": "population", "quote": "pilonidal wound healing by secondary intention" }, { "field": "intervention", "quote": "topical applications of hydrogel, silver, honey, zinc, selected foam materials, negative pressure wound therapy, platelet rich plasma, and plant extracts" }, { "field": "primaryOutcome", "quote": "which topical agent or dressing is effective in promoting pilonidal wound healing by secondary intention" }, { "field": "result", "quote": "there is some evidence to suggest that topical applications of hydrogel, silver, honey, zinc, selected foam materials, negative pressure wound therapy, platelet rich plasma, and plant extracts may promote wound healing" }, { "field": "limitations", "quote": "evidence remains insufficient in light of methodological limitations and biases of the studies" }, { "field": "comparator", "quote": "Topical treatment using polyhexamethylene biguanide and silver may be beneficial in reducing bacterial burden" } ] }, { "id": "pmid:26050953", "pmid": "26050953", "doi": "10.1016/j.ijsu.2015.05.048", "nctId": null, "pmcid": null, "title": "Medical grade honey in the management of chronic venous leg ulcers", "firstAuthor": "Holland", "multipleAuthors": true, "journal": "Int J Surg", "year": 2015, "design": "systematic-review", "n": 5, "nField": "reported", "population": "people with chronic venous leg ulcers", "intervention": "medical grade honey applied to the wound", "comparator": "standard wound therapy", "primaryOutcome": "wound healing and related clinical outcomes", "result": "mixed findings across studies, with no conclusive evidence of benefit", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a review of only five studies, including conflicting trials and weaker cohort/case series evidence with methodological flaws", "directness": "indirect", "limitations": "contradictory randomised trial results, one trial showing more adverse effects, and two supporting studies described as lower grade evidence with numerous methodological faults", "followUp": "", "plainFinding": "No conclusive evidence honey helps.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26050953/", "sourceText": "A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was: In patients with chronic venous leg ulcers (CVLU), does the use of medical grade honey as compared to standard wound therapy improve clinical outcomes? A total of 299 papers were identified using the search protocol described, of which five represented the best evidence available to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Two randomised controlled trials arrived at contradictory conclusions: one showing better outcomes for CVLU healing with use of honey over standard wound therapy and the other showing equivalent outcomes but more adverse effects. A third randomised controlled trial showed a non-significant reduction in bacterial colonisation of CVLU with honey compared to standard therapy. Two further studies--a prospective cohort study and a case series--supported the use of honey, but these were of lower grade evidence and had numerous methodological faults. Therefore, the clinical bottom line is that there is no conclusive evidence that honey improves outcome in patients with CVLU, and until more robust trials are conducted, its benefit should be considered unproven.", "provenance": [ { "field": "n", "quote": "of which five represented the best evidence available to answer the clinical question" }, { "field": "population", "quote": "In patients with chronic venous leg ulcers (CVLU)" }, { "field": "intervention", "quote": "the use of medical grade honey" }, { "field": "comparator", "quote": "as compared to standard wound therapy" }, { "field": "primaryOutcome", "quote": "improve clinical outcomes" }, { "field": "result", "quote": "there is no conclusive evidence that honey improves outcome in patients with CVLU, and until more robust trials are conducted, its benefit should be considered unproven" } ] }, { "id": "pmid:26039296", "pmid": "26039296", "doi": "10.1590/0104-1169.0020.2550", "nctId": null, "pmcid": "PMC4458999", "title": "Combined therapy of Ulmo honey (Eucryphia cordifolia) and ascorbic acid to treat venous ulcers", "firstAuthor": "Calderon", "multipleAuthors": true, "journal": "Rev Lat Am Enfermagem", "year": 2015, "design": "case-series", "n": 18, "nField": "reported", "population": "adults with venous leg ulcers", "intervention": "topical Ulmo honey dressings plus oral vitamin C", "comparator": "no comparison group", "primaryOutcome": "complete healing of venous ulcers", "result": "all ulcers fully healed with no complications", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a small, uncontrolled study of only 18 patients with no comparison group, so it can't show the honey caused the healing.", "directness": "indirect", "limitations": "No control group, small sample size, descriptive design only", "followUp": "", "plainFinding": "All ulcers fully healed.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26039296/", "sourceText": "OBJECTIVE: to assess the clinical effect of topical treatment using Ulmo honey associated with oral ascorbic acid in patients with venous ulcers. METHOD: longitudinal and descriptive quantitative study. During one year, 18 patients were assessed who were clinically diagnosed with venous ulcer in different stages, male and female, adult, with a mean injury time of 13 months. Ulmo honey was topically applied daily. The dressing was applied in accordance with the technical standard for advanced dressings, combined with the daily oral consumptions of 500 mg of ascorbic acid. The monitoring instrument is the assessment table of venous ulcers. RESULTS: full healing was achieved in 100% of the venous ulcers. No signs of complications were observed, such as allergies or infection. CONCLUSION: the proposed treatment showed excellent clinical results for the healing of venous ulcers. The honey demonstrated debriding and non-adherent properties, was easy to apply and remove and was well accepted by the users. The described results generated a research line on chronic wound treatment.", "provenance": [ { "field": "n", "quote": "18 patients were assessed" }, { "field": "population", "quote": "patients with venous ulcers" }, { "field": "intervention", "quote": "Ulmo honey was topically applied daily" }, { "field": "intervention", "quote": "combined with the daily oral consumptions of 500 mg of ascorbic acid" }, { "field": "comparator", "quote": "longitudinal and descriptive quantitative study" }, { "field": "primaryOutcome", "quote": "full healing was achieved in 100% of the venous ulcers" }, { "field": "result", "quote": "full healing was achieved in 100% of the venous ulcers. No signs of complications were observed, such as allergies or infection." } ] }, { "id": "pmid:25945118", "pmid": "25945118", "doi": "10.1155/2015/910605", "nctId": null, "pmcid": "PMC4405215", "title": "Evaluation of the effects of a combination of Japanese honey and hydrocolloid dressing on cutaneous wound healing in male mice", "firstAuthor": "Mukai", "multipleAuthors": true, "journal": "Evid Based Complement Alternat Med", "year": 2015, "design": "animal", "n": null, "nField": "not-reported", "population": "mice with full-thickness skin wounds", "intervention": "Manuka honey plus hydrocolloid dressing", "comparator": "hydrocolloid dressing alone", "primaryOutcome": "wound area, reepithelialization and collagen deposition during healing", "result": "Manuka honey plus dressing healed slower than dressing alone, with smaller wound closure and delayed reepithelialization and collagen deposition", "resultDirection": "harm", "quality": "low", "qualityWhy": "small animal study without reported sample size, so results may not predict human wound healing", "directness": "indirect", "limitations": "Animal (mouse) model, sample size not reported, not human anorectal surgery setting", "followUp": "14 days", "plainFinding": "Slowed wound healing in mice", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25945118/", "sourceText": "The aim of this study was to evaluate the effect of the combined use of Japanese honey and hydrocolloid dressing (HCD) on cutaneous wound healing. Mice were divided into four groups: the Acacia (Japan) + HCD, Manuka (New Zealand) + HCD, Chinese milk vetch (Japan) + HCD, and HCD (control) groups. The mice received two full-thickness wounds. The wounds of the HCD group were covered with HCD, whereas those of the other groups were treated with 0.1 mL of the relevant type of honey, before being covered with HCD. Wound area was significantly smaller in the HCD group than in the Acacia + HCD and Manuka + HCD groups on day 13 and days 8-14, respectively. Moreover, compared with the HCD group, reepithelialization was delayed in the Acacia + HCD group and reepithelialization and collagen deposition were delayed in the Chinese milk vetch + HCD and Manuka + HCD groups. These results indicate that the combined use of Japanese honey and HCD does not promote cutaneous wound healing compared with the use of HCD alone. Thus, this method is probably not useful for promoting healing.", "provenance": [ { "field": "population", "quote": "Mice were divided into four groups" }, { "field": "intervention", "quote": "Manuka (New Zealand) + HCD" }, { "field": "comparator", "quote": "HCD (control) groups" }, { "field": "primaryOutcome", "quote": "Wound area was significantly smaller in the HCD group than in the Acacia + HCD and Manuka + HCD groups on day 13 and days 8-14, respectively." }, { "field": "result", "quote": "compared with the HCD group, reepithelialization was delayed in the Acacia + HCD group and reepithelialization and collagen deposition were delayed in the Chinese milk vetch + HCD and Manuka + HCD groups" }, { "field": "result", "quote": "these results indicate that the combined use of Japanese honey and HCD does not promote cutaneous wound healing compared with the use of HCD alone" } ] }, { "id": "pmid:25855854", "pmid": "25855854", "doi": null, "nctId": null, "pmcid": null, "title": "The efficacy and safety of natural honey on the healing of foot ulcers: a case series", "firstAuthor": "Mohamed", "multipleAuthors": true, "journal": "Wounds", "year": 2015, "design": "case-series", "n": 12, "nField": "reported", "population": "patients with chronic foot ulcers", "intervention": "natural honey applied to the wound with non-adhering dressing", "comparator": "none (no control group)", "primaryOutcome": "wound healing time", "result": "all ulcers healed with no scars, average healing time 3 weeks", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a small uncontrolled observation of only 12 patients with no comparison group, so it cannot show whether honey caused the improvement.", "directness": "indirect", "limitations": "No control group, small number of patients, and foot ulcers rather than anorectal surgical wounds.", "followUp": "4 weeks", "plainFinding": "Foot ulcers healed well with honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25855854/", "sourceText": "UNLABELLED: This clinical observation investigated the efficacy, cost-effectiveness, and acceptability of natural honey on the healing of a variety of chronic foot ulcers at the primary care level. MATERIALS AND METHODS: A total of 12 patients with foot ulcers utilizing natural honey as an effective alternative to more expensive, advanced wound products were followed. Cases were referred to Umgwailinah Primary Health Care Center, Doha, Qatar from different health centers and from Hamad General Hospital, Doha, Qatar. There were also self-referred cases. After rinsing the site with normal saline, natural honey was applied and the wound was covered by glycerin-impregnated gauze (Adaptic Non-Adhering Dressing, Systagenix, San Antonio, TX) to prevent the absorption of honey into the cotton gauze and away from the wound site. Patients were followed on a daily basis for an average of 4 weeks. RESULTS: All ulcers healed with no contractures or scars with a mean healing time of 3 weeks. There was a 75% reduction in the dressing budget of the health center and a high level of satisfaction among both health professionals and patients. Patients' pain levels were reduced significantly after using natural honey, as evidenced by the use of the Visual Analog Scale. CONCLUSION: The use of natural honey in the management of chronic foot ulcers proved to be efficacious, cost-effective, and acceptable by both clinicians and patients.", "provenance": [ { "field": "n", "quote": "A total of 12 patients with foot ulcers" }, { "field": "population", "quote": "a variety of chronic foot ulcers" }, { "field": "intervention", "quote": "natural honey was applied and the wound was covered by glycerin-impregnated gauze" }, { "field": "comparator", "quote": "natural honey as an effective alternative to more expensive, advanced wound products" }, { "field": "primaryOutcome", "quote": "the efficacy, cost-effectiveness, and acceptability of natural honey on the healing of a variety of chronic foot ulcers" }, { "field": "result", "quote": "All ulcers healed with no contractures or scars with a mean healing time of 3 weeks." }, { "field": "followUp", "quote": "Patients were followed on a daily basis for an average of 4 weeks." } ] } ], "faqs": [ { "q": "Has manuka honey been tested after hemorrhoidectomy or anal fistula surgery specifically?", "a": "No. The only anorectal study found is a trial on pilonidal sinus wounds, which found no significant difference in healing time between honey and standard dressing alone. No trial has looked at hemorrhoidectomy or fistula surgery wounds." }, { "q": "Should I stop using manuka honey on my wound?", "a": "If a clinician recommended it as part of your care, ask them directly, since some studies found it can slow healing or irritate wounds in other settings. Don't substitute it for the wound care your surgeon has actually prescribed." }, { "q": "Is manuka honey safe to put on an open wound?", "a": "It isn't clearly unsafe, but it isn't clearly safe either. Some studies found it slowed healing or damaged tissue, and one case report linked topical honey to a serious infection concern in an infant, so open or deep wounds deserve caution." }, { "q": "If honey doesn't clearly help, what does help anorectal wounds heal?", "a": "The studies reviewed here don't test alternatives like sitz baths or specific dressings in anorectal surgery, so this review can't recommend a replacement. Follow the aftercare plan your surgeon gave you, and ask them about options if the wound isn't healing well." }, { "q": "Why do so many studies seem to say honey helps wounds?", "a": "Most of those studies are about different wounds entirely, such as diabetic foot ulcers, burns, or dental sockets, not anorectal surgery. They can't be read as direct evidence for this specific question." }, { "q": "Should I stop using manuka honey on my wound?", "a": "If you're using it after anorectal surgery, there's no good evidence it helps, and some studies in other wound types found it actually slowed healing or caused tissue damage. It's reasonable to stop and use the wound care your surgeon recommends instead, such as sitz baths and standard dressings; if you have concerns, ask your surgeon before changing anything." } ], "patientTakeaway": "No study has shown that manuka honey meaningfully helps wounds from hemorrhoidectomy, anal fistula surgery, or pilonidal sinus excision heal faster or better; the one closest trial found no real difference. Several studies in other wound types found honey can slow healing or irritate tissue, so it isn't a clearly safe stand-in for proper aftercare. Use the wound care plan your surgeon gave you, and call them if the wound looks infected, isn't healing, or you're unsure.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"Honey\"[Mesh] OR manuka[tiab]) AND (\"Wound Healing\"[Mesh] OR \"Wounds and Injuries\"[Mesh] OR wound*[tiab]) AND (surg*[tiab] OR anorectal[tiab] OR hemorrhoidectomy[tiab] OR \"anal fistula\"[tiab] OR \"pilonidal sinus\"[tiab] OR dressing*[tiab])" }, "pubmedQueryTranslation": "(\"Honey\"[MeSH Terms] OR \"manuka\"[Title/Abstract]) AND (\"Wound Healing\"[MeSH Terms] OR \"Wounds and Injuries\"[MeSH Terms] OR \"wound*\"[Title/Abstract]) AND (\"surg*\"[Title/Abstract] OR \"anorectal\"[Title/Abstract] OR \"hemorrhoidectomy\"[Title/Abstract] OR \"anal fistula\"[Title/Abstract] OR \"pilonidal sinus\"[Title/Abstract] OR \"dressing*\"[Title/Abstract])", "searchedOn": "2026-10-05", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Does Manuka Honey Heal Wounds After Surgery?", "description": "No trial has tested manuka honey on hemorrhoidectomy or fistula wounds; 6 of 78 related studies found signs it can harm healing." }, "lastChecked": "2026-10-05", "lastChanged": "2026-10-05", "nextCheckDue": "2026-11-05", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-05" }, "status": "published" }