Dehisced surgical oncologic wound in an infant

A male infant of 2.5 months old suffered from an abdominal retroperitoneal tumor. After a fine needle aspiration (FNA) biopsy was unsatisfactory to form an evident diagnosis, an open biopsy was performed. After histologic confirmation, the patient was diagnosed with an abdominal retroperitoneal neuroblastoma, and he was hospitalized at the PICU. 

A 2.5 months old oncological infant patient

Six days after the exploratory abdominal operation, the wound presented signs of inflammation with redness in appearance and the presence of slough, despite daily changing of dressings and use of local antiseptics. Culture swabs from the trauma bed presented Klebsiella pneumonia, one of the highly resistant bacteria that are endemic in PICU. Treatment of the wound with MGH was started (day 0) because inflammation and presence of necrotic tissue indicated stagnation of the wound and possible dehiscence.

Medical-Grade Honey treatment

The wound was treated with daily Medical-Grade Honey (MGH) monotherapy and closely monitored.

Results after treatment

After three days, dehiscence became evident at both ends of the surgical wound. Signs of inflammation decreased as shown by the decreased red colour at day eight. On day nine, the sutures were removed, and the surgical trauma epithelialized during the next days without signs of inflammation (day 14). The dehisced wounds were fully healed at day 18 with a smooth appearance of the surgical line. The neuroblastoma was successfully treated using chemotherapy and surgery.

Product: L-Mesitran Ointment

Case study done by: E. Smaropoulos, MD PhD, e-mail:

Discussion on effects of Medical-Grade Honey

The skin of preterm neonates is not completely developed which make them vulnerable to extravasation-induced injuries. Since these preterm neonates often have several comorbidities and are dependent on parenteral food, medication and fluid, they are at high risk of these injuries. Evidence-based treatment strategies are lacking, and therefore we investigated the use of MGH to improve extravasation-induced wound repair in this highly vulnerable patient group.

MGH for wound care is promising as they possess both antimicrobial and pro-healing capacity. The application of MGH covers the wound and prevents invading pathogens and infection. The antimicrobial activity is orchestrated by the low pH, strong osmotic action and production of hydrogen peroxide which is toxic for bacteria. In addition, MGH contains substances as propolis and chrysin that have an anti-inflammatory effect. The pro-healing effects of MGH are demonstrated by the autolytic debridement and stimulation of wound healing. Part of this may be orchestrated by the osmotic effects and stimulation of angiogenesis and epithelialization. 

Conclusion treatment infant

We showed that MGH was very well tolerated by this highly delicate preterm neonate and did not demonstrate any sensation of pain due to the application or use of MGH. The restricted use of MGH in neonates and the concerns about toxicity and botulism are ungrounded as MGH is gamma-sterilized and any spores of Clostridium are killed, without inactivating enzymes necessary for wound repair. 

In conclusion, MGH is safe, easy to apply and cost-effective to treat an extravasation-induced injury in a highly delicate neonatal patient. MGH therapy can be recommended as the first line of treatment and should be considered to treat a variety of wounds.