The role of MEDIHONEY in treating acute and chronic wounds of our nation s military
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1 The role of MEDIHONEY in treating acute and chronic wounds of our nation s military Kara S. Couch, MS, CRNP, CWS Complex Wound and Limb Salvage Center Bethesda, MD
2 Agenda My clinical practice Why MEDIHONEY? What can it do? A Review of Cases Impact on my practice Tips & Pointers Q&A
3 My Clinical Focus War Wounded who served in Iraq and Afghanistan Treat many dehisced incisions, partial take of splitthickness skin grafts, abscesses, donor sites Also, treat retirees, dependents Age range 26 weeks 100+ yrs old Acute and chronic wounds
4 MEDIHONEY Promoting Autolytic Debridement through to Healing Derived from the pollen and nectar of a specific Leptospermum species of plant in New Zealand Unique among honey maintains its effectiveness even in the presence of wound fluid Shown in randomized controlled trial where the mean healing time was significantly faster for wounds treated with MEDIHONEY impregnated dressings when compared to conventional dressings 1 Two key mechanisms of action create an optimal environment for wound healing High Osmolarity and Low ph 1. Kamaratos AV, Tzirogiannis KN, Iraklianou SA, Panoutsopoulos GI, Kanellos IE, Melidonis AI. Manuka honey-impregnated dressings in the treatment of neuropathic diabetic foot ulcers. Int Wound J ; 9: 1-7.
5 High Osmolarity MEDIHONEY s high osmotic potential draws fluid from deeper tissue to the wound surface Works with the body s natural processes to promote autolytic debridement to cleanse debris and necrotic tissue from the wound
6 Low ph 0 Wound healing ] Wound healing favors an acidic environment MEDIHONEY ph Neutral Wound breakdown Chronic wounds have an elevated alkaline ph (between ) 14 The low ph of MEDIHONEY ( ) helps to lower the ph within the wound environment 2,3, which has been shown to have wound healing benefits Gethin G, Cowman S. Changes in ph of chronic wounds when honey dressing is used. In: Wounds UK Conference Proceedings; November Wounds UK, Aberdeen. 3. Milne SD, Connolly P. The influence of different dressings on the ph of the wound environment. J Wound Care Feb;23(2):53 4, Leveen H, Falk G, Borek B, Diaz C, Lynfield Y, Wynkoop B, Mabunda GA et al. Chemical acidification of wounds. An adjuvant to healing and the unfavourable action of alkalinity and ammonia. Annals of Surgery (6):
7 Two Mechanism of Action Promoting Autolytic Debridement Slough, eschar, and elevated ph High osmotic pull bathes wound Low ph impacts wound bed Non viable tissue is removed Baseline Clean Wound Bed
8 Case Review
9 Case 1 Central Necrosis in Juncture of Incision 26 yo USA SGT Right AKA tight closure central necrosis at juncture of incisions MIST ultrasound and MEDIHONEY Calcium alginate daily
10 Case 1 Central Necrosis in Juncture of Incision Day 1 Wound bed completely covered by eschar and sough Pt does not need to return to OR Pt. cannot proceed to prosthetic fitting for R leg
11 Case 1 Central Necrosis in Juncture of Incision Day 14 Eschar liquefied and removed; Small amount of slough remains Wound contracting, continued treatment plan of MEDIHONEY 3-5 times a week
12 Case 1 Central Necrosis in Juncture of Incision Day 40 Wound nearly closed Proceeded with socket fitting and amputee rehab
13 Case 1 Central Necrosis in Juncture of Incision Day 1 Day 14 Day 40
14 Case 2 Dehisced Wound Following Surgery 67 yo female with Stage III ovarian cancer S/P TAH BSO On chemo Taking oral hydromorphone and diazepam for pain control Open abdominal wound after laparotomy on NPWT
15 Case 2 Dehisced Wound Following Surgery Initial presentation 5 days post surgery with NPWT in place
16 Case 2 Dehisced Wound Following Surgery Wound Management: Debridement MIST ultrasound MEDIHONEY Calcium alginate/bordered foam Pain control MIST ultrasound therapy Pre med 1 hprior to wound care with oral meds Infection risk Immunosuppressed
17 Case 2 Dehisced Wound Following Surgery Day 21 MEDIHONEY helped to clean up the wound bed Proceeded to put pt. back on NPWT
18 Case 2 Dehisced Wound Following Surgery Wound Management, Part II Time for NPWT again Current pain regimen NOT effective in controlling her pain during dressing changes Added Fentanyl oralets 200 mcg with each dressing change IN ADDITION to her regularly scheduled meds Use of contact layer between NPWT sponge and wound bed
19 Case 2 Dehisced Wound Following Surgery Healed! Cont. on fentanyl for approx 4 6 weeks with NPWT changes Was able to stop them for about 1 month prior to complete closure 1 year later: wound still healed, cancer re occurred
20 Case 2 Dehisced Wound Following Surgery Day 1 MEDIHONEY Calcium Alginate to clean up wound Day 21 4 Months later Clean wound bed NPWT initiated Healed
21 Case 3 Dehiscence of Transhumeral Amputation Closure 32yo M s/p dismounted IED blast Triple amputation, polymicrobial wound infection RUE s/p traumatic transhumeral amputation with multiple attempts at closure. S/P neurectomy, incision healing by secondary intention
22 Case 3 Dehiscence of Transhumeral Amputation Closure Day 1 L THA wound Wound bed 70% slough, 30% granulation MEDIHONEY Calcium Alginate
23 Case 3 Dehiscence of Transhumeral Amputation Closure Day 7 Rapid improvement After 1 week of MEDIHONEY + Mepilex dressings changed daily Fully granulated wound bed Rapid epithelialization at wound edges
24 Case 3 Dehiscence of Transhumeral Amputation Closure Day 14 Healed Arm is now ready to be fitted for prosthesis
25 Case 3 Dehiscence of Transhumeral Amputation Closure Day 1 Day 7 Day 14
26 Case 4 Dehiscent Faciotomy Wound Day 1 26 yo 4 th year medical student Had 4 compartment fasciotomy for exercise induced compartment syndrome Developed cellulitis 1 month postop at medial calf incision Dehisced in 3 areas MEDIHONEY Paste and foam
27 Case 4 Dehiscent Faciotomy Wound Day 15 Minimal adherent slough Edges closing in
28 Case 4 Dehiscent Faciotomy Wound Day 30 Smaller wounds healed Larger wound nearly closed
29 Case 4 Dehiscent Faciotomy Wound Day 1 Day 15 Day 30
30 Case 5 Left Lower Leg Heterotopic Ossification (Bone growth through tissue) 25 yo USA LT extensive skin grafts to posterior LLE Severe heterotopic ossification to be resected soon Known colonization issues On Juven and Doxycycline Exfix at ankle Daily wound care and clinic appts qmwf MEDIHONEY Paste and bordered foam
31 Case 5 Left Lower Leg Heterotopic Ossification (Bone growth through tissue) Just out of the hospital Jan 2014
32 Case 5 Left Lower Leg Heterotopic Ossification (Bone growth through tissue) Day 1 Presented to wound clinic a day later Wounds need to be closed prior to scheduling addl. surgery
33 Case 5 Left Lower Leg Heterotopic Ossification (Bone growth through tissue) Day 14 Much improved, almost closed
34 Case 5 Left Lower Leg Heterotopic Ossification (Bone growth through tissue) Day 40 Healed! March 2014
35 Case 5 Left Lower Leg Heterotopic Ossification (Bone growth through tissue) Day 100 Postop..Again! Removal of HO posterior knee New wounds created from protrusion on calf
36 Case 5 Left Lower Leg Heterotopic Ossification (Bone growth through tissue) Day 120 Much improved Continued treatment with sharp debridement and Medihoney gel/alginate. Covered with bordered foam. 36
37 Case 5 Left Lower Leg Heterotopic Ossification (Bone growth through tissue) Where Are We Now?
38 Impact of MEDIHONEY to Practice Think of MEDIHONEY when your goal is to: Clean up wounds (remove slough and fibrin) Promote acute wound healing (granulation and epithelialization of edges) Gently remove eschars Dehisced wounds Kick start chronic wounds
39 How To Choose??? Hydrogel HONEY Cadexomer Iodine Hydrofiber /Calcium Alginate Foam Specialty Absorbent Contact layer Epithelial GEL Granulated GEL Exudative Calcium Alginate Fibrin Calcium Alginate Slough Any Eschar Calcium Alginate Depth Calcium Alginate **All above topicals can be covered by foam/gauze and they all require a secondary dressing. ***SQUARES indicate a dressing is acceptable to be used for that particular wound type.
40 TIPS & Pointers Cover Gel, Paste with nonadherent Cover Calcium Alginate with absorptive Make sure that you cut the alginate to FIT the wound bed, Train your staff and the caregiver!
41 What not to do MEDIHONEY Calcium Alginate should fit inside the wound edges, not around the outside!!
42 Questions? Kara S. Couch, MS, CRNP, CWS Complex Wound and Limb Salvage Center Bethesda, MD
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