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This case study examines the treatment of a clinically infected stage III heel pressure ulcer in an 85-year-old female patient with underlying health conditions. Previous treatment had been ineffective, leading to the use of our Medical Grade Honey products L-Mesitran Soft and L-Mesitran Tulle. After surgical debridement, the MGH products, combined with a secondary foam dressing, were applied every 48 hours. Over the first four weeks, the patient already experienced several positive benefits.
An 85-year-old female patient presented with a heel pressure ulcer on her right foot. The ulcer was caused by prolonged immobility due to hip arthroplasty and was classified as stage III since the underlying subcutaneous tissue was affected. The patient also presented with hypertensive heart disease, hyperlipidemia, dementia, and a vitamin B12 and calcium deficiency. Previous treatment with topical neomycin sulfate spray for >2 months was ineffective. Upon first evaluation, the wound dimensions were 5 cm in width and 5 cm in length. The ulcer showed clinical signs of infection, including delayed healing, low levels of exudate, hard necrotic eschar, and pain.
What is a Heel Pressure ulcer?
They are one of the most common pressure ulcers and are usually severe due to the vulnerability of the heel. Non-healing heel pressure ulcers have a massive impact on the patient’s quality of life and are often caused by bacterial infections.
¨Medical Grade Honey as a methods
The thick eschar was removed by surgical debridement. L-Mesitran Soft was applied to the wound and followed by L-Mesitran Tulle. The L-Mesitran products were combined with a secondary foam dressing. Wound dressings were performed by the healthcare professional at the patient’s home at 48-hour intervals.
Results visible after a few weeks
After 4 weeks of treatment with medical grade honey (MGH) products of L-Mesitran, the patient experienced considerably less pain. Besides this, the exudate was significantly reduced and the wound showed healthy granulation tissue. Due to the positive developments of the wound, the dressing changes were transitioned to every 4 days instead of every 2 days. 17 weeks after the start of the treatment with L-Mesitran products the heel pressure ulcer was completely healed without any further complications.
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Discussion on treating Heel Pressure Ulcers with Medical Grade Honey
Pressure ulcers at the heel are one of the most common pressure ulcers and are usually severe due to the vulnerability of the heel(2, 3). Non-healing heel pressure ulcers have a massive impact on the patient’s quality of life and are often caused by bacterial infections(4). 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(5).
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(6, 7). 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(8, 9).
In this study, the diagnosis of infection was made by clinical assessment of different signs of local infection rather than using wound swabs and subsequent microbial culturing. Swabs can be considered redundant in case of local infections because MGH exerts a broad-spectrum antimicrobial effect it is expected to resolve the infection independently of the pathogen. On multiple occasions, L-Mesitran products have been reported to successfully treat infected diabetic foot ulcers and pressure sores(10, 11). Notably, a bedsore coccyx in an 8-year-old patient was almost completely healed after 32 days of treatment with L-Mesitran(11). Moreover, L-Mesitran healed extravasation wounds in neonates without complications(12), highlighting its safety for patients. Another case series reported that L-Mesitran significantly improved heel pressure ulcers in the elderly by removing malodor, promoting debridement, and stimulating granulation(13).
In conclusion, MGH-based products are clinically and cost-effective for treating hard-to-heal pressure ulcers, such as heel pressure ulcers and can be proposed as an alternative or complementary to antibiotics and surgery. Furthermore, MGH-based products are easy to apply at home and are cost-effective. This will lead to improving the patient’s quality of life.
More articles about Heel Pressure Ulcers?
We have done more studies about Medical Grade Honey and the positive effects it has on the treatment of heel pressure ulcers.
Are you interested in more cases related to MGH and the treatment of heel pressure ulcers? Click on one of the following articles.
- Papanikolaou GE, Gousios G, Cremers NAJ. Use of Medical-Grade Honey to Treat Clinically Infected Heel Pressure Ulcers in High-Risk Patients: A Prospective Case Series. Antibiotics (Basel). 2023;12(605).
- Greenwood C. Heel pressure ulcers: understanding why they develop and how to prevent them. Nurs Stand. 2022;37(2):60-6.
- VanGilder C, MacFarlane GD, Harrison P, Lachenbruch C, Meyer S. The demographics of suspected deep tissue injury in the United States: an analysis of the International Pressure Ulcer Prevalence Survey 2006-2009. Adv Skin Wound Care. 2010;23(6):254-61.
- Agale SV. Chronic leg ulcers: epidemiology, aetiopathogenesis, and management. Ulcers. 2013;2013(Article ID 413604):9.
- Cremers NA. Something old, something new: does medical grade honey target multidrug resistance? J Wound Care. 2021;30(3):160-1.
- Mandal MD, Mandal S. Honey: its medicinal property and antibacterial activity. Asian Pac J Trop Biomed. 2011;1(2):154-60.
- Almasaudi S. The antibacterial activities of honey. Saudi J Biol Sci. 2021;28(4):2188-96.
- 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).
- 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.
- Nair HKR, Tatavilis N, Pospisilova I, Kucerova J, Cremers NAJ. Medical-Grade Honey Kills Antibiotic-Resistant Bacteria and Prevents Amputation in Diabetics with Infected Ulcers: A Prospective Case Series. Antibiotics (Basel). 2020;9(9).
- Smaropoulos E, Cremers NAJ. Treating severe wounds in pediatrics with medical grade honey: A case series. Clin Case Rep. 2020;8(3):469-76.
- Smaropoulos E, Cremers NAJ. Medical-Grade Honey for the Treatment of Extravasation-Induced Injuries in Preterm Neonates: A Case Series. Adv Neonatal Care. 2021;21(2):122-32.
- Gray DW, R. Mesitran Ointment Case Studies. Wounds UK. 2005;1(3):Suppl II, 32-5.