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Honey & Wound Healing
Topical Application of Honey in Treatment of Abdominal
Wound Disruption

Winit Phuapradit, MD, MPH and Nopadol Saropala, MRCOG
Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Aust NZ J Obstet Gynaecol 1992 ; 32 : 4 : 381
(Author’s email-rawpp@mahidol.ac.th)

Summary : The usefulness of honey application as an alternative method of managing abdominal wound disruption was assessed. Fifteen patients whose wound disrupted after        caesarean section were treated with honey application and wound approximation by micropore tape instead of the traditional method of wound dressing with subsequent resuturing. We achieved excellent results in all the cases with complete healing within 2 weeks. Honey application is inexpensive, effective and avoids the need to resuture which also requires general anaesthesia.

            Abdominal wound disruption after Caesarean section though uncommon often causes great anxiety to the patient. Not only does it cause discomfort, increase length of hospitalization and expense, it disrupts the initial bonding between the patient and her child. The usual treatment includes wound cleaning, administration of antibiotics and resuturing when appropriate.

            Honey has been used as an adjuvant to treatment of decubitus ulcer, the wound from radical operation for carcinoma of the vulva and burns (1-4). It accelerates wound healing by having several desirable properties such as providing a source of energy, being hypertonic, sterile and bacteriocidal (5,6).

            The purpose of this study was to assess the usefulness of honey in the treatment of abdominal wound disruption after Caesarean section. Its efficacy and length of hospitalization were prospectively assessed.

PATIENTS AND METHODS : Wound disruption generally refers to a separation of an abdominal wound. Patients included in this study were those with disruption the whole length of the wound and as far down as the rectus sheath, i.e. the peritoneum and rectus sheath had remained intact.

                Between August, 1990 and February, 1992, 15 patients with abdominal wound disruptions after Caesarean section (all were lower midline incision and resulted from infection) received treatment. Swabs were taken from the wounds for culture and sensitivity examinations before starting treatment. After initial cleaning of the wound with normal saline solution, a thin layer of unboiled commercial honey was laid throughout the length of the wound, which was then approximated with micropore tape. The wound was covered with sterile top dressing in the usual manner. This procedure was carried out twice daily and at the time of dressing the amount and characteristic of discharge, foul smell, slough, granulation tissue and signs of healing were noted. Subjective evaluation such as satisfaction for the result of treatment was also assessed. After 1 week another wound swab was taken for culture and sensitivity. When the wound was considered shallow with healthy granulation tissue present, the patients were allowed home to continue performing the dressing themselves every 2-3 days. They were seen again in the clinic 7-14 days later and again at the routine postpartum clinic visit 6 weeks after delivery. Prior to the study period we also reviewed the traditional method of treatment for abdominal wound disruption after Caesarean section i.e. wound cleaning, administration of antibiotics and resuturing under general anaesthesia.

Result : During the study period of 19 months there were 15 patients and their ages ranged from 18-32 years (mean 24.2 years). The organisms isolated from swab culture were mixed coliforms (40 %), Staphylococcus aureus (20%), Peptostreptococcus (13.3 %), Escherichia coli (13.3 %), Streptococcus (6.7 %), Bacteroides fragilis (6.7 %). In every case slough and necrotic tissue were replaced by granulation tissue and advancing epithelialization within 2 days. The foul-smelling wounds became odourless within 1 week after dressing with honey. All of the second wound swab cultures performed 1 week after treatment with honey yielded no growth of organisms. None of the 15 wounds needed resuturing. Complete healing of the wound within 7 days after treatment occurred in 11 patients (73 %) ; in the remaining 4 it occurred within 2 weeks. The mean (range) length of stay in the hospital after the treatment was 4.5 (2-7) days. No allergic or other adverse reactions were observed.

            Retrospective analysis of the traditional treatment by wound cleaning with hydrogen peroxide, Dakin solution and wound packing with gauze soaked with normal saline solution with subsequent resuturing were carried out in 19 patients between January, 1988 and July, 1990. The mean (range) age of the patients was 22.9 (19-28) years. The mean (range) length of stay in the hospital after the treatment was 11.5 (9-18) days. One patient developed hepatocellular jaundice from general anaesthesia. Two patients had reinfection of the wounds. One of the wounds treated with honey is shown in figure 1. All the patients were satisfied with the treatment especially because an operation was avoided.

Discussion : It has been known for a long time that honey can accelerate wound healing, for it possesses a property which causes debridement, hastens absorption of oedema and is bacteriocidal. It creates deodorization of infected wounds, promotes granulation tissue formation and accelerates epithelialization (1-6).

            Previous reports on the use of honey focused on the treatment of shallow wounds such as from burn injury or superficial ulcers (1-4). In this study we have shown that honey also be used in deeply infected abdomnal wound after Caesarean section with effective results. The treatment is simple and inexpensive. The honey need not be sterile as it already possesses a bacteriocidal property. This only holds true if the material is without any artefacts. It is prudent to check this by putting a drop of the honey on filter paper ; pure and uncontaminated honey will not pass through it. The bacteriocidal activity of honey was also demonstrated by this study, the wounds becoming sterile within 1 week of treatment. This bacteriocidal effect may be due to an inhibine-bacteriocidal substance present in honey, low pH and hygroscopic properties of honey (6).

            In this study we achieved excellent results in every case in terms of efficacy, length of hospitalization and patient’s satisfaction. We have shown that honey application with wound approximation by adhesive tape is an alternative method in the treatment of abdominal wound disruption and is certainly worthwhile in developing countries where cost and availability of medical facilities are limited.