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      Honey dressing: a missed way for orthopaedic wound care

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          Abstract

          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.

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          Most cited references41

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          Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses.

          In 673 open fractures of long bones (tibia and fibula, femur, radius and ulna, and humerus) treated from 1955 to 1968 at Hennepin County Medical Center, Minneapolis, Minnesota, and analyzed retrospectively, the infection rate was 12 per cent from 1955 to 1960 and 5 per cent from 1961 to 1968. In a prospective study from 1969 to 1973, 352 patients were managed as follows: débridement and copious irrigation, primary closure for Type I and II fractures and secondary closure for Type III fractures, no primary internal fixation except in the presence of associated vascular injuries, cultures of all wounds, and oxacillin-ampicillin before surgery and for three days postoperatively. In 158 of the patients in the prospective study the initial wound cultures revealed bacterial growth in 70.3 per cent and the infection rate was 2.5 per cent. Sensitivity studies suggested that cephalosporin is currently the prophylactic antibiotic of choice. For the Type III open fractures (severe soft-tissue injury, segmental fracture, or traumatic amputation), the infection rates were 44 per cent in the retrospective study and 9 per cent in the prospective study.
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            Honey: its medicinal property and antibacterial activity.

            Indeed, medicinal importance of honey has been documented in the world's oldest medical literatures, and since the ancient times, it has been known to possess antimicrobial property as well as wound-healing activity. The healing property of honey is due to the fact that it offers antibacterial activity, maintains a moist wound condition, and its high viscosity helps to provide a protective barrier to prevent infection. Its immunomodulatory property is relevant to wound repair too. The antimicrobial activity in most honeys is due to the enzymatic production of hydrogen peroxide. However, another kind of honey, called non-peroxide honey (viz., manuka honey), displays significant antibacterial effects even when the hydrogen peroxide activity is blocked. Its mechanism may be related to the low pH level of honey and its high sugar content (high osmolarity) that is enough to hinder the growth of microbes. The medical grade honeys have potent in vitro bactericidal activity against antibiotic-resistant bacteria causing several life-threatening infections to humans. But, there is a large variation in the antimicrobial activity of some natural honeys, which is due to spatial and temporal variation in sources of nectar. Thus, identification and characterization of the active principle(s) may provide valuable information on the quality and possible therapeutic potential of honeys (against several health disorders of humans), and hence we discussed the medicinal property of honeys with emphasis on their antibacterial activities.
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              Honey as a topical treatment for wounds

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                Author and article information

                Contributors
                salam_ilizarov@yahoo.com , ABDELSALAM.YOUSSEF@fmed.bu.edu.eg
                shareeftraigy07@gmail.com , shareefaltraigy@fmed.bu.edu.eg
                dr_mahmoud_ibrahim@yahoo.com , Mahmoud.ibrahim@fmed.bu.edu.eg
                Journal
                Int Orthop
                Int Orthop
                International Orthopaedics
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0341-2695
                1432-5195
                16 August 2022
                16 August 2022
                November 2022
                : 46
                : 11
                : 2483-2491
                Affiliations
                GRID grid.411660.4, ISNI 0000 0004 0621 2741, Department of Orthopaedic Surgery, Benha Faculty of Medicine, , Benha University, ; Farid Nada Street, Kalyubia, Benha, Post Office 13518 Egypt
                Author information
                http://orcid.org/0000-0003-2405-9595
                http://orcid.org/0000-0002-4782-4694
                http://orcid.org/0000-0001-6785-1756
                Article
                5540
                10.1007/s00264-022-05540-9
                9556393
                35971015
                53dab991-1e1a-4292-b1dd-4f41be1977b7
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 7 June 2022
                : 4 August 2022
                Funding
                Funded by: Benha University
                Categories
                Original Paper
                Custom metadata
                © The Author(s) under exclusive licence to SICOT aisbl 2022

                Orthopedics
                orthopaedic wounds,open fractures,infected non-union,honey dressing,postoperative infections,ilizarov

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