Patient history

An adult female dog was presented to the clinic with a large burn present on her lower back as a result of hot frying oil. The burn stretched all the way from one side to the other and covered the entire lower back of the animal (Figure 1). Because of the race of the animal, a lot of hair covered the animal and the wound initially appeared smaller than its actual size. Only after shaving the full extent became clear.

Products used: L-Mesitran Ointment, Tulle, Active

Case study by: Alex Brander, veterinairewondzorg.nl

Methods

After hair removal on the affected area, the wound was mechanically debrided and cleaned with 0,45% saline solution. A daily dose of 1,5 mg/kg of bodyweight Prednisone was described to combat the inflammatory phase. After which treatment with medical grade honey (MGH) products was started . After 2 weeks, the animal was deemed stable enough to be treated at home. The owner of the animal applied L-Mesitran Tulle, supplemented with L-Mesitran Ointment. The dressings were fixated by a wearable jacket wrapped around the dressings. At a later stage, the smaller wound beds were treated with L-Mesitran Active, because they nicely fit the wound size and its ease of use.

Results

The wound appeared to contain sloughy and necrotic tissue with debris upon arrival at the clinic (Figure 1, Day 0). For the first two weeks, there was little to no progression in the healing of the wound, and treatment was focused on removing necrotic tissue and general debridement. After two weeks, no more necrotic tissue was present and the wound was granulating satisfactory (Figure 1, day 14). Thereafter, the wound healed rapidly with epithelialization visible on the wound edges (Figure 1, day 18).  The wound bed continued to close by reepithelialization, with one large and several smaller wounds remaining  (Figure 1, day 33). The smaller ones were completely healed a month later (Figure 1, day 61), until the main wound completely closed as well (Figure 1, day 91). The large burn was healed approximately three months after the start of treatment.


Discussion

Burns are at risk of infection, mainly by Pseudomonas and Staphylococcus strains (1), that could be present in fresh burn wounds like presented in this case. Although an infection (or indication thereof) was absent in this case, there have been studies performed on preventing infections in horses. They illustrated that subcutaneous application of MGH in horses, primarily on surgical wounds and lacerations, could prevent infection and dehiscence of these wounds (2, 3). This shows that besides MGH being effective against established infections in wounds (4), preventative application in (fresh) wounds of MGH is also effective. Furthermore, MGH may provide an alternative to more expensive topical or systemic wound medications for the management of extensive burns. MGH aids in speeding up granulation tissue formation and reducing second intention healing time in dogs (5).

References

  1. Maddocks SE, Jenkins RE. Honey: a sweet solution to the growing problem of antimicrobial resistance? Future Microbiol. 2013 Nov;8(11):1419-29. doi: 10.2217/fmb.13.105. PMID: 24199801.
  2. Mandel HH, Sutton GA, Abu E, Kelmer G. Intralesional application of medical grade honey improves healing of surgically treated lacerations in horses. Equine Vet J. 2020 Jan;52(1):41-45. doi: 10.1111/evj.13111. Epub 2019 Apr 15. PMID: 30895637.
  3. Gustafsson, Kajsa & Tatz, Amos & Slavin, Roni & Dahan, Roee & Wiessam, Dvm & Abu Ahmad, Wiessam & Sutton, Gila & Kelmer, Gal & Authors,. (2020). Will Local Intraoperative Application of Medical Grade Honey in the Incision Protect Against Incisional Infection in Horses Undergoing Colic Surgery? Prophylactic intra-incisional local application of medical-grade honey (L-mesitran) significantly decreases the incidence of incisional infection in horses undergoing colic surgery.
  4. Pleeging CCF, Wagener FADTG, de Rooster H, Cremers NAJ. Revolutionizing non-conventional wound healing using honey by simultaneously targeting multiple molecular mechanisms. Drug Resist Updat. 2022 May;62:100834. doi: 10.1016/j.drup.2022.100834. Epub 2022 Apr 5. PMID: 35427872.
  5. G, Maravelis & Voutsinou, Agni & N, Tsampa & Papazoglou, Lysimachos. (2015). Management of an extensive partial and full thickness skin burn in a dog with the aid of medical honey. Hellenic Journal of Companion Animal Medicine. 4.