You’ll have to forgive me for my indulgence in penning this article. I am a honey convert. A manuka evangelist! So I’m going to take the opportunity to lecture on my favourite subject and try to explain the theory behind using stuff that comes out of a bee’s bum in the management of complex wounds. Sounds ridiculous, doesn’t it?
A Quick History Lesson
Honey has always been a prestige product. The Egyptians chose it to accompany the dead on their journey to the next world, it was used as currency as far back as 9000 years ago and the Greek Gods existed on a mix of honey and milk called ‘ambrosia’.
In medicine it would appear that the Greeks got in first, as they did with so many scientific advancements. Aristotle used it on wounds in 322BC and Hippocrates (the Father of Medicine) recommended it for wounds, sores and ulcers. It is mentioned as a wound treatment in both the Bible and the Koran. More recently it was used in the trenches durig the First World War, apparently on the infected wounds of horses as well as the soldiers.
Once antibiotics were discovered and developed honey rather fell out of favour but as a profession we are now learning to rely less on antibiotics. In the face of MRSA, reducing antibiotic resistance and reliance is a vital part of medical advancement.
What Sort of Honey?
Research has shown that the best honey for wound management purposes is that produced solely from the nectar of the Manuka bush, indigenous to New Zealand. It has superior anti-microbial properties to other sorts of honey and is graded according to its UMF – Unique Manuka Factor. Beware imitations! A lot of food-grade ‘Manuka Honey’ actually only contains a small percentage of manuka and is blended with other honeys. As there isn’t a huge global crop of manuka bushes, supply is limited and a lot of manufacturers dilute the product. Food labelling is less rigorous than medical labelling and may use word such as ‘active’, ‘bioactive’ or ‘factor’, none of which have any defined meaning. They often use a number on the label to mimic the UMF system but have unreliable provenance and untested anti-microbial properties. Food grade manuka is also pasteurised, which removes helpful wound-healing enzymes whereas medical honey is sterilised via radiation which leaves them intact. Thus food-grade manuka shouldn’t be used for wound care. Medical-grade manuka honey with a UMF of at least +10 is the best choice.
Several manufacturers produce honey in tubes. These can be quite hard to use. My top tip is to give up trying to squeeze the honey out of the nozzle: cut the bottom off the tube and squeeze it out the wide end instead! Warming the tube in your hands or a mug of warm water first also helps its handleability. I prefer to use dressings already impregnated with honey. Kruuse make two versions: a thin one (like Melolin) and a thicker one for when the wound is producing a lot of exudate and therefore needs a more absorbent dressing. Both have a UMF of +15. Ready-impregnated dressings are a lot cleaner and easier to use and can be cut to size, reducing waste. Providing the exudate is being sufficiently absorbed these dressings can be left in place for 5-7 days, saving a lot of money on bandaging materials and a lot of time re-dressing.
Honey is best suited to infected wounds: those that are dirty, sloughing, discharging or necrotic. It is also useful for burns, puncture wounds, abscesses etc. Although it has a strong antimicrobial action it is important to use antibiotics too when the infection has got into the horse’s blood system to prevent septicaemia. It is not an appropriate treatment for very fresh or bleeding wounds and in these a plain hydrogel (eg. Intrasite) should be used instead.
As an afternote it is worth mentioning that honey shouldn’t be used in any patient (human or equine) who has previously suffered an anaphylactic reaction to a bee-sting.
A couple of pictures to illustrate wounds in the early stages of treatment.
There is also a brilliant, if slightly gory, case report here.
All wound/product photos courtesy of Kruuse UK.