Conclusion

The concerted action of the various physical properties and bioactivities in honey explains the remarkable results obtained clinically, especially when appropriately selected honeys are used and sufficient honey is held in place on the wound for these factors to work. Although some of the mechanisms of action are speculative, there is, nevertheless, a great deal of published evidence for honey having such actions on wounds. The excellent clinical evidence of overall effectiveness is presented in Chapter 9. The use of honey on human beings over a period of more than 4,000 years, with no adverse effects coming to light, is evidence of its effectiveness as a healing agent.

References

Ahmed AK, Hoekstra MJ, Hage JJ, Karim RB (2003) Honey-medicated dressing: transformation of an ancient remedy into modern therapy. Ann Plast Surg 50(2): 143–7; discussion 147–8

Alcaraz A, Kelly J (2002). Treatment of an infected venous leg ulcer with honey dressings. Br J Nurs 11(13): 859–60, 862, 864–6

Al-Swayeh OA, Ali ATM (1998) Effect of ablation of capsaicin-sensitive neurons on gastric protection by honey and sucralfate. Hepato- Gastroenterology 45(19): 297–302

Al-Waili NS, Boni NS (2003) Natural honey lowers plasma prostaglandin concentrations in normal individuals. J Medicinal Food 6(2): 129–33

Al-Waili NS, Saloom KY (1999) Effects of topical honey on post-operative wound infections due to gram positive and gram negative bacteria following caesarean sections and hysterectomies. Eur J Med Res 4: 126–30

Aminu SR, Hassan AW, Babayo UD (2000) Another use of honey. Trop Doct 30: 250–51

Anoukoum T, Attipou KK, Ayite A, James YE, James K (1998) Le traitment des gangrenes perineales et de la sphere genitale par du miel. Tunis Med 76(5): 132–5

Armon PJ (1980) The use of honey in the treatment of infected wounds. Trop Doct 10: 91

Bang LM, Buntting C, Molan PC (2003) The effect of dilution on the rate of hydrogen peroxide production in honey and its implications for wound healing. J Alternative Complementary Med 9(2): 267–73

Belfield WO, Golinsky S, Compton MD (1970) The use of insulin in open wound healing. Vet Med: Small Animal Clinician 65(5): 455–60

Bergman A, Yanai J, Weiss J, Bell D, David MP (1983) Acceleration of wound healing by topical application of honey. An animal model. Am J Surg 145: 374–6

Betts JA, Molan PC (2001) A pilot trial of honey as a wound dressing has shown the importance of the way that honey is applied to wounds. 11th Conference of the European Wound Management Association, Dublin, Ireland

Betts JA, Molan PC (2002) Results of a pilot trial of manuka honey as a dressing for infected chronic wounds. 4th Australian Wound Management Association Conference, Adelaide, Australia

Blomfield R (1973) Honey for decubitus ulcers. J Am Med Assoc 224(6): 905

Bloomfield E (1976) Old remedies. J R Coll Gen Pract 26: 576

Bostek CC (1989) Oxygen toxicity: An introduction. J Am Assoc Nurse Anesthetists 57(3): 231–7

Braniki FJ (1981) Surgery in Western Kenya. Ann R Coll Surg Engl 63: 348–52

Bulman MW (1955) Honey as a surgical dressing. Middlesex Hospital J 55: 188–9

Buntting C (2001) The production of hydrogen peroxide by honey and its relevance to wound healing. University of Waikato, New Zealand

Burdon RH (1995) Superoxide and hydrogen peroxide in relation to mammalian cell proliferation. Free Radic Biol Med 18(4): 775–94

Burlando F (1978) Sull’azione terapeutica del miele nelle ustioni. Minerva Dermatologica 113: 699–706

Cavanagh D, Beazley J, Ostapowicz F (1970) Radical operation for carcinoma of the vulva. A new approach to wound healing. J Obstet Gynaecol British Commonwealth 77(11): 1037–40

Chant A (1999) The biomechanics of leg ulceration. Ann R Coll Surg Engl 81: 80–5 Chirife J, Scarmato G, Herszage L (1982) Scientific basis for use of granulated sugar in treatment of infected wounds. Lancet i (6 March): 560–1

Chung LY, Schmidt RJ, Andrews AM, Turner TD (1993) A study of hydrogen peroxide generation by, and antioxidant activity of, Granuflex™ (DuoDERM™) Hydrocolloid Granules and some other hydrogel/ hydrocolloid wound management materials. Br J Dermatol 129(2): 145–53

Church J (1954) Honey as a source of the anti-stiffness factor. Federation Proc Am Physiol Soc 13(1): 26

Cooper RA, Molan PC, Krishnamoorthy L, Harding KG (2001) Manuka honey used to heal a recalcitrant surgical wound. Eur J Clin Microbiol Infect Dis 20: 758–9

Cullen B, Smith R, McCulloch E, Silcock D, Morrison L (2002) Mechanism of action of PROMOGRAN, a protease modulating matrix, for the treatment of diabetic foot ulcers. Wound Repair Regen 10(1): 16–25

Czech MP, Lawrence Jr, JC, Lynn WS (1974) Evidence for the involvement of sulphydryl oxidation in the regulation of fat cell hexose transport by insulin. Proc Natl Acad Sci U S A 71(10): 4173–77

Dumronglert E (1983) A follow-up study of chronic wound healing dressing with pure natural honey. J Natl Res Council Thailand 15(2): 39–66

Dunford C, Cooper R, Molan PC (2000a) Using honey as a dressing for infected skin lesions. Nurs Times 96(14 NT-plus): 7–9

Dunford C, Cooper R, Molan PC, White R (2000) The use of honey in wound management. Nurs Standard 15(11): 63–8

Dunford CE, Hanano R (2004) Acceptability to patients of a honey dressing for non-healing venous leg ulcers. J Wound Care 13(5): 193–7

Edwards JV, Howley P, Cohen IK (2004) In vitro inhibition of human neutrophil elastase by oleic acid albumin formulations from derivatized cotton wound dressings. Int J Pharm 284(1–2): 1–12

Edwards JV, Yager, DR, Cohen IK, Diegelmann RF, Montante S, Bertoniere N, Bopp AF (2001) Modified cotton gauze dressings that selectively absorb neutrophil elastase activity in solution. Wound Repair Regen 9(1): 50–8

Efem SEE (1993) Recent advances in the management of Fournier’s gangrene: Preliminary observations. Surgery 113(2): 200–4

El-Banby M, Kandil A, Abou-Sehly G, El-Sherif ME, Abdel-Wahed K (1989) Healing effect of floral honey and honey from sugar-fed bees on surgical wounds (animal model). Fourth International Conference on Apiculture in Tropical Climates, Cairo, International Bee Research Association, London Esmon CT (2004) Crosstalk between inflammation and thrombosis. Maturitas 47(4): 305–14

Farouk A, Hassan T, Kashif H, Khalid SA, Mutawali I, Wadi M (1988) Studies on Sudanese bee honey: laboratory and clinical evaluation. Int J Crude Drug Res 26(3): 161–8

Flohé L, Beckmann R, Giertz H, Loschen G (1985) Oxygen-centred free radicals as mediators of inflammation. In: Sies H, Oxidative Stress. Academic Press, London, Orlando: 403–35

Frankel S, Robinson GE, Berenbaum MR (1998) Antioxidant capacity and correlated characteristics of 14 unifloral honeys. J Apicultural Res 37(1): 27–31

Gheldof N, Engeseth NJ (2002) Antioxidant capacity of honeys from various floral sources based on the determination of oxygen radical absorbance capacity and inhibition of in vitro lipoprotein oxidation in human serum samples. J Agricultural Food Chemistry 50(10): 3050–55

Gheldof N, Wang X, Engeseth NJ (2002) Identification and quantification of antioxidant components of honeys from various floral sources. J Agricultural Food Chemistry 50: 5870–77

Gheldof N, Wang XH, Engeseth NJ (2003) Buckwheat honey increases serum antioxidant capacity in humans. J Agricultural Food Chemistry 51(5): 1500–5

Grimble GF (1994) Nutritional antioxidants and the modulation of inflammation: theory and practice. New Horizons 2(2): 175–85

Gupta SK, Singh H, Varshney AC, Prakash P (1992) Therapeutic efficacy of honey in infected wounds in buffaloes. Indian J Animal Sciences 62(6): 521–3

Harris S (1994) Honey for the treatment of superficial wounds: a case report and review. Primary Intention 2(4): 18–23

Haydak MH, Crane E, Duisberg H, Gochnauer TA, Morse RA, White JW, Wix P (1975) Biological Properties of Honey. Heinemann, London Hejase MJ, Bihrle R; Coogan CL (1996) Genital Fournier’s gangrene: experience with 38 patients. Urology 47(5): 734–9

Helm BA, Gunn JM (1986) The effect of insulinomimetic agents on protein degradation in H35 hepatoma cells. Mol Cell Biochem 71(2): 159–66

Hutton DJ (1966) Treatment of pressure sores. Nurs Times 62(46): 1533–34

Kandil A, El-Banby M; Abdel-Wahed K, Abou-Sehly G, Ezzat N (1987) Healing effect of true floral and false nonfloral honey on medical wounds. J Drug Res (Cairo) 17(1–2): 71–5

Kaufman T, Eichenlaub EH, Angel MF, Levin M, Futrell JW (1985) Topical acidification promotes healing of experimental deep partial thickness skin burns: a randomised double-blind preliminary study. Burns 12: 84–9

Kaufman T, Levin M, Hurwitz DJ (1984) The effect of topical hyperalimentation on wound healing rate and granulation tissue formation of experimental deep second degree burns in guinea-pigs. Burns 10(4): 252–6

Keast-Butler J (1980) Honey for necrotic malignant breast ulcers. Lancet ii (11 October): 809

Kingsley A (2001) The use of honey in the treatment of infected wounds: case studies. Br J Nurs 10(22) Tissue Viability Supplement: s13–s20

Koshio O, Akanuma Y, Kasuga M (1988) Hydrogen peroxide stimulates tyrosine phosphorylation of the insulin recepter and its tyrosine kinase activity in intact cells. Biochem J 250: 95–101

Kumar A, Sharma, V K; Singh, H P; Prakash, P; Singh, S P (1993) Efficacy of some indigenous drugs in tissue repair in buffaloes. Indian Veterinary J 70(1): 42–4

Lopez JE, Mena B (1968) Local insulin for diabetic gangrene. Lancet i: 1199 McInerney RJF (1990) Honey — a remedy rediscovered. J R Soc Med 83: 127

Misirlioglu A, Eroglu S, Karacaoglan N, Akan M, Akoz T, Yildirim S (2003) Use of honey as an adjunct in the healing of split-thickness skin graft donor site. Dermatol Surg 29(2): 168–72

Murrell, GAC, Francis MJO, Bromley L (1990) Modulation of fibroblast proliferation by oxygen free radicals. Biochem J 265: 659–65

Mutjaba Quadri KH (1999) Manuka honey for central vein catheter exit site care. Semin Dialysis 12(5): 397–8

Natarajan S, Williamson D, Grey J, Harding KG, Cooper RA (2001) Healing of an MRSA-colonised, hydroxyurea-induced leg ulcer with honey. J Dermatol Treatment 12: 33–6

Niinikoski J, Kivisaari J, Viljanto J (1977) Local hyperalimentation of experimental granulation tissue. Acta Chiropida Scand 143: 201–6

Nychas GJ, Dillon VM, Board RG (1988) Glucose, the key substrate in the microbiological changes in meat and certain meat products. Biotechnol Appl Biochem 10: 203–31

Oluwatosin OM, Olabanji JK, Oluwatosin OA, Tijani LA, Onyechi HU (2000) A comparison of topical honey and phenytoin in the treatment of chronic leg ulcers. Afri J Med Sci 29(1): 31–4

Oryan A, Zaker SR (1998) Effects of topical application of honey on cutaneous wound healing in rabbits. J Veterinary Med Series A45 (3): 181–8

Ossanna PJ, Test ST, Matheson NR, Regiani S, Weiss SJ (1986) Oxidative regulation of neutrophil elastase-alpha-1-proteinase inhibitor interactions. J Clinical Investigation 77: 1939–51

Peppin GJ, Weiss SJ (1986) Activation of the endogenous metalloproteinase, gelatinase, by triggered human neutrophils. Proc Natl Acad Sci U S A 83: 4322–26

Phuapradit W, Saropala N (1992) Topical application of honey in treatment of abdominal wound disruption. Aust N Z J Obstet Gynaecol 32(4): 381–4

Pierre EJ, Barrow RE, Hawkins HK, Nguyen TT, Sakurai Y, Desai M, Wolfe RR, Herndon DN (1998) Effects of insulin on wound healing. J Trauma, Injury, Infect Crit Care 44(2): 342–5

Poon VK, Burd A (2004) In vitro cytotoxity of silver: implication for clinical wound care. Burns 30(2): 140–7

Postmes T, Vandeputte J (1999) Recombinant growth factors or honey? Burns 25: 676–8

Postmes TJ, Bosch MMC, Dutrieux R, van Baare J, Hoekstra MJ (1997) Speeding up the healing of burns with honey. An experimental study with histological assessment of wound biopsies. In: Mizrahi A, Lensky Y, eds. Bee Products: Properties, Applications and Apitherapy. Plenum Press, New York: 27–37

Rao GN, Berk BC (1992) Active oxygen species stimulate vascular smooth muscle cell growth and proto-oncogene expression. Circ Res 70: 593–9

Richards L (2002) Healing infected recalcitrant ulcers with antibacterial honey. 4th Australian Wound Management Association Conference, Adelaide, Australia.

Robson V (2000) Personal communication. University Hospital Aintree, Liverpool, UK

Robson V, Dunford C, Molan PC, Cooper RA (2001) The use of honey in wound management. Innovations in Wound Care Conference, Cardiff, UK

Robson V, Ward RG, Molan PC (2000) The use of honey in split skin grafting. 10th Conference of the European Wound Management Association, Harrogate, UK

Ryan GB, Majno G (1977) Inflammation. Kalamazoo, Michigan, Upjohn

Schramm DD, Karim M, Schrader HR, Holt RR, Cardetti M, Keen CL (2003) Honey with high levels of antioxidants can provide protection to healthy human subjects. J Agricultural Food Chemistry 51(6): 1732–35

Schreck R, Rieber P, Baeuerle PA (1991) Reactive oxygen intermediates as apparently widely used messengers in the activation of the NF-?B transcription factor and HIV-1. EMBO J 10(8): 2247–58

Schultz GS, Sibbald RG, Falanga V, Ayello EA, Dowsett C, Harding K, Romanelli M, Stacey MC, Teot L, Vanscheidt W (2003) Wound bed preparation: a systematic approach to wound management. Wound Rep Regen 11 (suppl 1): s1–s28

Silver IA (1980) The physiology of wound healing. In: TK Hunt, Wound Healing and Wound Infection: theory and surgical practice. Appleton-Century- Crofts, New York: 11–28

Silvetti AN (1981) An effective method of treating long-enduring wounds and ulcers by topical applications of solutions of nutrients. J Dermatol Surg Oncol 7(6): 501–8

Sinclair RD, Ryan TJ (1994) Proteolytic enzymes in wound healing: the role of enzymatic debridement. Aust J Dermatol 35: 35–41

Somerfield SD (1991) Honey and healing. J R Soc Med 84(3): 179

Stewart J (2002) Therapeutic honey used to reduce pain and bleeding associated with dressing changes. 4th Australian Wound Management Association Conference, Adelaide, Australia

Subrahmanyam M (1991) Topical application of honey in treatment of burns. Br J Surg 78(4): 497–8

Subrahmanyam M (1993) Honey-impregnated gauze versus polyurethane film (OpSite®) in the treatment of burns — a prospective randomised study. Br J Plastic Surg 46(4): 322–3

Subrahmanyam M (1994) Honey-impregnated gauze versus amniotic membrane in the treatment of burns. Burns 20(4): 331–3

Subrahmanyam M (1996) Honey dressing versus boiled potato peel in the treatment of burns: a prospective randomized study. Burns 22(6): 491–3

Subrahmanyam M (1998) A prospective randomised clinical and histological study of superficial burn wound healing with honey and silver sulfadiazine. Burns 24(2): 157–61

Subrahmanyam M, Sahapure AG, Nagane NS, Bhagwat VR, Ganu JV (2001) Effects of topical application of honey on burn wound healing. Ann Burns Fire Disasters XIV(3): 143–5

Suguna L, Chandrakasan G, Ramamoorthy U, Thomas Joseph K (1993) Influence of honey on biochemical and biophysical parameters of wounds in rats. J Clin Biochemistry Nutrition 14: 91–9

Suguna L, Chandrakasan G, Thomas Joseph K (1992). Influence of honey on collagen metabolism during wound healing in rats. J Clin Biochemistry Nutrition 13: 7–12

Taks JM (2000) Eusol managment of burns. Trop Doct 30: 54

Tanaka H, Hanumadass M, Matsuda H, Shimazaki S, Walter RJ, Matsuda T (1995) Hemodynamic effects of delayed initiation of antioxidant therapy (beginning two hours after burn) in extensive third-degree burns. J Burn Care Rehabil 16(6): 610–15

Tatnall FM, Leigh IM, Gibson JR (1991) Assay of antiseptic agents in cell culture: conditions affecting cytotoxicity. J Hosp Infect 17(4): 287–96

Tur E, Bolton L, Constantine BE (1995) Topical hydrogen peroxide treatment of ischemic ulcers in the guinea pig: Blood recruitment in multiple skin sites. J Am Acad Dermatol 33(2 Pt 1): 217–21

Vardi A, Barzilay Z, Linder N, Cohen HA, Paret G, Barzilai A (1998) Local application of honey for treatment of neonatal postoperative wound infection. Acta Paediatr 87(4): 429–32 Viljanto J, Raekallio J (1976) Local hyperalimentation of open wounds. Br J Surg 63: 427–30

Wadi M, Al-Amin H, Farouq A, Kashef H, Khaled SA (1987) Sudanese bee honey in the treatment of suppurating wounds. Arab Medico 3: 16–18

Weheida SM, Nagubib HH, El-Banna HM, Marzouk S (1991) Comparing the effects of two dressing techniques on healing of low grade pressure ulcers. J Med Research Institute, Alexandria University 12(2): 259–78

Weiss SJ, Peppin G, Ortiz X, Ragsdale C, Test ST (1985) Oxidative autoactivation of latent collagenase by human neutrophils. Science 227: 747–9

White JW (1975). Composition of honey. In: Crane E, ed. Honey: A comprehensive survey. Heinemann, London: 157–206

Wood B, Rademaker M, Molan PC (1997) Manuka honey, a low cost leg ulcer dressing. N Z Med J 110: 107

Zaiß (1934) Der Honig in äußerlicher Anwendung. Münchener Medizinische Wochenschrift Nr 49: 1891–93

Zumla A, Lulat A (1989) Honey — a remedy rediscovered. J R Soc Med 82(7): 384–5

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