A 9-year-old dog was first presented to the clinic with gastrointestinal (GI) problems. Ultrasonography revealed a modified stomach wall, no peristaltic activity, hepatomegaly, and intestinal loops without content. One week later, the patient returned to the clinic with a swollen front left limb, edema, and fever. The tissue on the leg became necrotic within 24 hours and formed an open wound the following day. The patient was originally treated with the antibiotic Ceftriaxone, administered via IV for the swelling and edema. The patient showed signs of improvement after antibiotic treatment for the following days via systemic support therapy. However, ultrasonographically the patient worsened and a stomach neoplasm was considered. Initially, the wound was formed as a result of mechanical and surgical debridement and the swelling was resolved by this process. The resulting wound was fairly deep with an indented appearance (Figure 1, day 2).
Products: L-Mesitran Soft
Case study done by: Alexandra Peteoaca DVM, Faculty of Veterinary Medicine, Bucharest, Romania
For wound care, the wound was lavaged with Ringer´s lactate and mechanically and surgically debrided of all non-viable tissue without sedation. A thick layer of L-Mesitran Soft (Medical grade honey (MGH)) was applied topically, covered with non-woven gauze, cast padding, and self-adhesive cohesive wrap. The bandages were changed daily. A biopsy was performed during the second bandage change, which revealed a regenerative process as well as necrotic tissue in other samples.
Before treatment with MGH, a swab of the infected was performed, which showed Klebsiella spp infection. On day 4, the wound started to show granulating tissue which continued the following days (Figure 1, day 4, 5, 7, and 9). On days 7 and 9, improved angiogenesis was shown by a deep red tint and epithelialization was visible around the wound edges. On day 9, the wound had a healthy appearance with no signs of infection or swelling. Unfortunately, the patient passed away before the wound could improve further. The cause of death was unrelated to the wound and the post-mortem examination revealed necrotic tissue in other tissues of the body, combined with ongoing GI issues the patient was suffering from.
Figure 1: Wound healing progression for a necrotic wound in the left limb.
Although the patient was presented with GI issues, the wound developed and subsequently became necrotic rather quickly after admission (one week). GI lymphoma was considered by the veterinarian, mainly via ultrasonography and observance of clinical signs. Edema and swelling of lymph nodes are symptoms of GI lymphoma, alongside necrotic lesions and a life expectancy between 3 to 77 days (1). In cases where edema is present, honey does not only reduce and prevent future swelling in a multitude of wounds (2). Future swelling is reduced via the 80% sugar (glucose, fructose, and sucrose) content of MGH, and these have hygroscopic activity. This activity helps to draw out lymph fluid and clean the wound (3). Honey and MGH in particular also enhance wound healing by creating a moist wound environment, promoting autolytic debridement, angiogenesis and reepithelialization. Edema can also increase the pressure on the wound, leading to an increase in total wound healing time. Moreover, oxidative and inflammatory stress is reduced (3-7). The increased granulation and angiogenesis promotion by MGH works in tandem with its antimicrobial activity. By exerting this activity, inflammation is decreased which allows for scar formation, increased wound repair, and cell migration (8).
MGH is a great tool for treating infected wounds caused by edema and debridement. The combination of autolytic debridement, hygroscopic activity, angiogenesis promotion, tissue granulation and epithelialization ensures that swelling does not return in wounds previously containing edema. MGH promotes healthy wound healing by maintaining a moist environment, having antimicrobial activity and promoting cell migration/proliferation.
Sogame, Naoko; Risbon, Rebecca; Burgess, Kristine E. (2018). Intestinal lymphoma in dogs: 84 cases (1997–2012). Journal of the American Veterinary Medical Association, 252(4), 440–447. doi:10.2460/javma.252.4.440
Molan, P. C. (2006). The Evidence Supporting the Use of Honey as a Wound Dressing. The International Journal of Lower Extremity Wounds, 5(1), 40–54. doi:10.1177/1534734605286014
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 NA. Medical grade honey for the treatment of paediatric abdominal wounds: a case series. J Wound Care. 2020;29(2):94-9.
Smaropoulos E, Cremers NAJ. The pro-healing effects of medical grade honey supported by a pediatric case series. Complement Ther Med.2019;45:14-.
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. Advances in Neonatal Care. 2020;in press.
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.