Efficacy Of Honey Dressing Versus Mechanical Debridement In Healing Of Ulcers With Biofilms A Comparative Study

Abstract

Chronic wounds are the significant health problems globally. The treatment and management of chronic wounds is challenging to the health care providers. Microbial Bioburden in wounds are the important factors responsible for the chronicity of wounds. The effective management of bacterial bioburden is an essential element of wound care. Bacteria can exist in at least two different phenotypic growth forms: the first being single, fast-growing cells i.e. the planktonic form; the second as aggregated communities of slow-growing cells in a biofilm form1. Management of biofilm in chronic wounds is rapidly becoming a primary objective of wound care. However management of biofilm is an undeniably complex task. Beyond the basic steps of initial prevention (use of anti-biofilm agent), removal (debridement, de-sloughing) and prevention of reformation (use of antimicrobial agents), patient, environmental and clinical parameters that must be considered. Honey on the wound bed not only draws material out of the wound, but also prevents biofilm formation and cross-contamination. It provides a barrier effect on an open wound preventing further infection from external contamination. Method of Collection of Data: All patients admitted in the department of general surgery in Shri B.M Patil Medical collage during the study period of October 2015 to June 2017 with ulcers were initially subjected to the identification of biofilm in ulcers. Ulcers with biofilm were included in the study. A total of 90 patients were taken up for study and divided randomly into Honey and Debridement group with 45 in each. Ulcers were treated with dressing soaked with honey in honey group and debridement with povidone XI iodine dressings in debridement group. Once in 5days ulcers were evaluated for the presence of biofilm and assess the healing process and once the ulcers were healed completely or the culture was sterile or negative for biofilm were underwent definitive surgery. Statistical analysis was done by Fisher‘s exact test and Chi square test. RESULTS: In our study total of 90 patients were included. Most of the patients were in the age group of 61-75yrs in honey group and 45-60yrs in debridement group with mean age of 49.8±19.0yrs and 53.4±17.5yrs in honey and debridement groups respectively with male predominance in both groups 82.2%. Most of the ulcers were chronic 60% in honey and 68.9% in debridement group. S.aureus was the common organism isolated in this study. Mean time for formation of healthy granulation tissue was 14.7±5.4 in honey group whereas 17.9±7.5 in debridement group which was significant (p=0.025). All patients were discharged after the definitive management without any complications, 40% patients in honey group and 57.8% patients in debridement group were discharged after 30days with mean hospital stay was 34.1±15.7days & 36.0±15.8days in honey and debridement groups respectively. CONCLUSSION: Honey dressing is more effective when compared to the mechanical debridement with povidone iodine dressing in achieving complete healing, reducing the hospital stay and increasing the comfort (i.e repeated debridement under local or spinal anesthesia, cost and pain) to the subjects with chronic wounds.