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| UNIQUE THERAPIES FOR DIFFICULT WOUNDS macrophages to further cleanse the wound.È]Ç SELECTING HONEY FOR HEALING 6OQBTUFVSJ[FE IPOFZ EFSJWFE GSPN QBSUJDVMBS GMPSBM TPVSDFT JO /FX ;FBMBOE BOE "VTUSBMJB TVDI BT .BOVLB IPOFZ IBT FOIBODFE BOUJCBDUFSJBM BDUJWJUZ BOE CFUUFS IFBMJOH QSPQFSUJFT UIBO TUPSF CPVHIU IPOFZ and IPOFZ GSPN CFFT GFE TVHBS GPS DPNNFSDJBM IPOFZ QSPEVDUJPO 6OQBTUFVSJ[FE IPOFZ BMTP BMMPXT BDUJWBUJPO PG HMVDPTF PYJEBTF #BDUFSJB BOE GVOHJ TVDDFTTGVMMZ USFBUFE CZ UIFTF UZQFT PG IPOFZ JODMVEF t &TDIFSJDIJB; DPMJ t 1SPUFVT NJSBCJMJT t 1TFVEPNPOBT BFSVHJOPTB t 4BMNPOFMMB UZQIJNVSJVN t 4FSSBUJB NBSDFTDFOT t 4UBQIZMPDPDDVT BVSFVT t 4USFQUPDPDDVT QZPHFOFT t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echanism of Action The antibacterial effects of honey can be attributed to iÌÃÊhi}hÊoÃmol>ÀiÌÞ]Ê>Vi`iÌÞ]Ê>n`Ê«iÀoÝi`iÊ>VÌiÛiÌÞ°3,4,5 UÊ nVÀi>Ãi`ÊoÃmol>ÀiÌÞÊ`À>ÜÃÊvlÕi`Ê>n`ÊlÞm«hÊvÀomÊ the underlying tissues and this fluid provides nourishment to the healing wound. UÊ oniÞ½ÃÊ« Ê Î°ÈqΰǮÊVÀi>ÌiÃÊ ÌhiÊ`iÃiÀi`Ê>Vi`iVÊ environment that has been shown to decrease bacterial growth, increase fibroblast activity, and inVÀi>ÃiÊoÝÞ}inÊÀili>Ãi]Ê>llÊovÊÜhiVhÊvÕÀÌhiÀÊ«Ào- mote wound healing. UÊ lÕVoÃiÊ oÝi`>ÃiÊ «Ào`ÕViÃÊ hÞ`Ào}inÊ «iÀoÝi`iÊ and gluconic acid, which provide the main anti- bacterial qualities of honey. The well-tolerated, loÜÊliÛilÃÊovÊhÞ`Ào}inÊ«iÀoÝi`iÊ«ÀomoÌiÊ>n}io- }iniÃiÃÊ>n`ÊviLÀoLl>ÃÌÊ>VÌiÛiÌÞ]Êinh>nVin}ÊoÝÞ}inÊ delivery to tissue.3 Research suggests that honey’s ability to enhance wound healing is related to release of inflammatory cytokines from surrounding tissue and attraction of Honey also appears to: UÊ VVil>À>ÌiÊÃloÕ}hin}ÊovÊ`iÛiÌ>liâi`ÊÌiÃÃÕi UÊ*ÀoÛi`iÊloV>lÊnÕÌÀiÌion UÊ iVÀi>ÃiÊ invl>mm>ÌoÀÞÊ ÀiëonÃiÊÜiÌhÊ >Ê «ÀoÌiV- tive layer of protein from wound turnover UÊ m«ÀoÛiÊi«iÌhili>liâ>Ìion°4 Application 1. Lavage & Debridement: See Wound Preparation. 2. Application: The amount of honey applied to the ÜoÕn`Ê`i«in`ÃÊonÊÌhiÊÃiâiÊovÊÌhiÊÜoÕn`°Ê oÀÊi>ÃiÊ ovÊ >««liV>Ìion]Ê «ÀiÃo>kÊ }>ÕâiÊ oÀÊ >LÃoÀLinÌÊ «>`ÃÊ in honey prior to application instead of pouring honey directly onto the wound. 3. Bandaging: Since honey does not interfere with L>n`>}iÊ>LÃoÀLinVÞ]ÊÜoÕn`ÊiÝÕ`>ÌiÊÜillÊÃÌ>ÞÊVon- tained within the bandage. However, to prevent honiÞÊvÀomÊooâin}ÊvÀomÊÌhiÊ`ÀiÃÃin}]Ê>ÊÃiVon`>ÀÞÊ occlusive or absorbent dressings may be warranted. 4. Bandage Changes: Frequency of bandage changes depends on how rapidly the honey is diluted by the ÜoÕn`ÊiÝÕ`>ÌiÊoÀÊÜhiÌhiÀÊÃÌÀikiÌhÀoÕ}hÊoVVÕÀÃ°Ê Disadvantages Disadvantages of using honey on topical wounds include: UÊ oniÞ½ÃÊ ÃÌiVkÞÊ VonÃiÃÌinVÞ]Ê ÜhiVhÊm>kiÃÊ iÌÊ `iv- ficult to use. UÊ ÌÃÊ VoÃÌÊ >n`Ê limiÌi`Ê >Û>il>LiliÌÞÊ ÃiiÊ Selecting Honey for Healing), which may delay initiation ovÊ ÌÀi>ÌminÌÊ iÌÊ ÌÞ«iV>llÞÊ Ì>kiÃÊ ÇÊ ÌoÊ £äÊ `>ÞÃÊ voÀÊ honiÞÊÌoÊ>ÀÀiÛiÊ>n`ÊiÌÊVoÃÌÃÊ>««ÀoÝim>ÌilÞÊfÓäÊvoÀÊ 10 to 12 ounces). UÊ/hiÊ «>inÊ iÌÊ >««i>ÀÃÊ ÌoÊ V>ÕÃiÊ ÜhinÊ >««lii`Ê ÌoÊ vÕll-ÌhiVkniÃÃÊÜoÕn`ÃÆÊ hoÜiÛiÀ]Ê `iÃVomvoÀÌÊ h>ÃÊ not been noted when applied to partial-thickness wounds.3 VINEGAR Vinegar (acetic acid) has been used to fight infections since 300 BC.10 Despite its antimicrobial properties, its use in wound treatment is controversial. onÌoÝiVÊVonVinÌÀ>ÌionÃÊ<Êä°ääÓx¯®Ê>ÀiÊÃli}hÌlÞÊ effective as an antibacterial agent against gram posi- tive and negative bacteria, such as S aureus and P aeruginosa.10,11 At this concentration, vinegar has no `iÌÀiminÌ>lÊivviVÌÃÊonÊviLÀoLl>ÃÌÃÊ>n`ÊkiÀ>ÌinoVÞÌiÃÆÊ however, it’s ineffective against E coli, Bacteroides fragilis, and Enterococcus. Studies have shown Ìh>ÌÊ`ilÕÌi`ÊÛini}>ÀÊÓ¯Ê>ViÌiVÊ>Vi`®ÊiÃÊivviVÌiÛiÊvoÀÊ treating ear infections, but the low pH may irritate inflamed skin.10 Studies have shown that acute wounds (eg, burns, lacerations) and chronic wounds (eg, pressure ulcers, infected surgical wounds) treated with honey heal faster than those treated with conventional therapies.4,6 14 Today’s Veterinary Practice July/August 2011