Deep wound following the removal of a melanoma

Products: L-Mesitran Tulle and Soft

Case study performed by: Pieter Kegels & Filip Kegels,Kegels Thuisverpleging, Sint-Gillis-Waas, Belgium.

A 67-year-old woman presented with a deep wound on her right lower leg. A few days prior, the patient got a small freckle checked in the hospital. There, a small biopsy was taken, confirming the presence of a melanoma. The following day, she was called back into the hospital for immediate removal of the melanoma. During surgery, more tissue had to be removed than anticipated, leaving the patient with a deep wound around the size of half a tennis ball. Therefore, a skin graft was taken from her upper leg and sutured into place on her lower leg. The wound was treated in the hospital for 2 days with povidone-iodine and surgeons expected a total treatment period of at least 3 months. After release from the hospital, the patient sought help from the local home care nurses, who commenced treatment with medical-grade honey (MGH).

Before each dressing change the wound was debrided gently to not damage the skin graft. Additionally, due to the severity of the wound, povidone-iodine was continued to be used for disinfection. L-Mesitran Soft was applied directly to the wound bed and covered with L-Mesitran Tulle. A simple gauze was used for fixation. Dressings were changed on a daily basis.

The MGH stimulated autolytic debridement and allowed for better gentle mechanical removal of debris, which became evident after 2 weeks of therapy. The MGH products were non-adherent allowing for pain-free dressing changes. Stitches were removed after 4 weeks of treatment, when the tissue underlying the skin graft grew to fill the gap. Only a minor wound was visible at this point, so dressing changes were switched to every 2-3 days. After a total treatment period of 5 weeks, the wound was fully healed. 

At this moment, the edge of the skin graft started showing a small, inflamed dot. It was suspected to be caused by the removal of the stitches. The small dot was opened to release pus. MGH was used on only this spot and the patient started using regular moisturizing cream to maintain the scar. The small spot was healed within one week.

MGH is an effective wound care product, as it simultaneously exerts antimicrobial and wound-healing effects via multiple mechanisms. These multifaceted effects not only contribute to the ability of MGH to treat a broad spectrum of bacteria, but it lacks the risk of resistance(1). The antimicrobial effects of MGH rely mainly on the acidic pH, the high osmotic pressure due

to the high sugar content, and the release of hydrogen peroxide after the enzymatic breakdown of sugar(2, 3). In addition to its antimicrobial activities, MGH also promotes wound healing by keeping the wound moist, stimulating autolytic debridement, and exerting anti-inflammatory and anti-oxidative effects(4, 5).

As demonstrated by this case, MGH proves highly effective in stimulating tissue growth after surgical removal of melanomas. In contrast to the expectations of the surgeons, meaning wound care would take at least 3 months, the wound healed in a remarkable 5 weeks. This highlights the pro-healing capacities of MGH. Moreover, the MGH therapy did not cause any complications for the skin graft but rather aided in maintaining the integrity of the skin graft. 

In conclusion, MGH can be used as a safe and effective therapy for wounds following surgical removal of melanomas.

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References 

  1. Cremers NA. Something old, something new: does medical grade honey target multidrug resistance? J Wound Care. 2021;30(3):160-1.
  2. Mandal MD, Mandal S. Honey: its medicinal property and antibacterial activity. Asian Pac J Trop Biomed. 2011;1(2):154-60.
  3. Almasaudi S. The antibacterial activities of honey. Saudi J Biol Sci. 2021;28(4):2188-96.
  4. Pleeging CCF, Coenye T, Mossialos D, de Rooster H, Chrysostomou D, Wagener F, et al. Synergistic Antimicrobial Activity of Supplemented Medical-Grade Honey against Pseudomonas aeruginosa Biofilm Formation and Eradication. Antibiotics (Basel). 2020;9(12).
  5. Smaropoulos E, Cremers NAJ. The pro-healing effects of medical grade honey supported by a pediatric case series. Complement Ther Med. 2019;45:14-8.