A comparative study to evaluate the effect of honey dressing and silver sulfadiazene dressing on wound healing in burn patients

ABSTRACT

To compare the effect of honey dressing and silver-sulfadiazene (SSD) dressing on wound healing in burn patients. Patients (n=78) of both sexes, with age group between 10 and 50 years and with first and second degree of burn of less than 50% of TBSA (Total body surface area) were included in the study, over a period of 2 years (2006-08). After stabilization, patients were randomly attributed into two groups: ‘honey group’ and ‘SSD group’. Time elapsed since burn was recorded. After washing with normal saline, undiluted pure honey was applied over the wounds of patients in the honey group (n=37) and SSD cream over the wounds of patients in SSD group (n=41), everyday. Wound was dressed with sterile gauze, cotton pads and bandaged. Status of the wound was assessed every third and seventh day and on the day of completion of study. Patients were followed up every fortnight till epithelialization. The bacteriological examination of the wound was done every seventh day. The mean age for case (honey group) and control (SSD group) was 34.5 years and 28.5 years, respectively. Wound swab culture was positive in 29 out of 36 patients who came within 8 hours of burn and in all patients who came after 24 hours. The average duration of healing in patients treated with honey and SSD dressing at any time of admission was 18.16 and 32.68 days, respectively. Wound of all those patients (100%) who reported within 1 hour became sterile with honey dressing in less than 7 days while none with SSD. All of the wounds became sterile in less than 21 days with honey, while tthis was so in only 36.5% with SSD treated wounds. The honey group included 33 patients reported within 24 hour of injury, and 26 out of them had complete outcome at 2 months of follow-up, while numbers for the SSD group were 32 and 12. Complete outcome for any admission point of time after 2 months was noted in 81% and 37% of patients in the honey group and the SSD group. Honey dressing improves wound healing, makes the wound sterile in lesser time, has a better outcome in terms of prevention of hypertrophic scarring and post-burn contractures, and decreases the need of debridement irrespective of time of admission, when compared to SSD dressing.

KEY WORDS

Honey dressing - silver-sulfadiazine dressing - wound healing in burn

• REFERENCES

• 1 Jaiswal AK, Aggarwal H, Solanki P, Lubana PS, Mathur RK, Odiya S. Epidemiological and socio-cultural study of burn patients in MY Hospital, Indore, India. Indian J Plast Surg 2007;40:158-63.
• 2 Subrahmanyam M. Honey dressing versus boiled potato peel in the treatment of burns: A prospective randomized study. Burns 1996;22:491-3.
• 3 Moore OA, Smith LA, Campbell F, Seers K, McQuay HJ, Moore RA. Systematic review of the use of honey as a wound dressing. BMC Complement Altern Med 2001;1:2.
• 4 Knox A. Harnessing honey's healing power. BBC– Excerpt from Tuesday 8th June 2004.
• 5 Wahdan H. Causes of the antimicrobial activity of honey. Infection 1998;26:26-31.
• 6 Waikato Honey Research Unit. Honey as an Antimicrobial Agent. November 16, 2006.
• 7 Schepartz AI, Subers MH. Catalase in honey. J Apicultural Res 1966;5:37-43.
• 8 Subrahmanyam M. Addition of antioxidant and polyethylene glycole 4000 enhances the healing property of honey in burns. Ann Burns Fire Disasters 1996;9:93-5.
• 9 Ozbek S, Ozgenel Y, Etoz A, Akin S, Kahveci R, Heper Y, et al. The effect of delayed admission in burn centers on wound contamination and infection rates. Ulus Travma Acil Cerrahi Derg 2005;11:230-7.
• 10 Onuba O, Udoidiok E. Hospital management of massive burns in the developing countries. Burns Incl Therm Inj 1987;13:386-90.
• 11 Goldenheim PD. An appraisal of povidone-iodine and wound healing. Postgrad Med J 1993;69:97-105.
• 12 Brånemark PI, Ekholm R. Tissue injury caused by wound disinfectants. J Bone Joint Surg Am 1967;49:48-62.
• 13 Knutson RA, Merbit LA, Creekmore MA, Snipes HG. Use of sugar and povidone-iodine to enhance wound healing: Five years experience. South Med J 1981;74:1329-35.
• 14 Chirife J, Herszage L, Joseph A, Kohn ES. In vitro study of bacterial growth inhibition in concentrated sugar solutions: Microbiological basis for the use of sugar in treating infected wounds. Antimicrob Agents Chemother 1983;23:766-73.
• 15 Rahal F, Mimica IM, Pereira V, Athié E. Sugar in the treatment of infected surgical wounds. Int Surg 1984;69:308.
• 16 Middleton K, Seal DV. Sugar as an aid to wound healing. Pharm J 1985;235:757-8.
• 17 Trouillet JL, Chastre J, Fagon JY, Pierre J, Domart Y, Gibert C. Use of granulated sugar in treatment of open mediastinitis after cardiac surgery. Lancet 1985;2:180-4.
• 18 Shimamoto Y, Shimamoto H, Fujihata H, Nakamura H, Matsuura Y. Topical application of sugar and povidone-iodine in the management of decubitus ulcers in aged patients. Hiroshima J Med Sci 1986;35:167-9.
• 19 Nagane NS, Ganu JV, Bhagwat VR. Efficacy of topical honey therapy against silver sulphadiazine treatment in burns: A biochemical study. Indian J Clin Biochem 2004;19:173-6.
• 20 Subrahmanyam M. A prospective randomised clinical and histological study of superficial burn wound healing with honey and silver sulfadiazine. Burns 1998;24:157-61.
• 21 Subrahmanyam M. Topical application of honey in treatment of burns. Br J Surg 1991;78:497-8.
• 22 Bulman MW. Honey as a surgical dressing. Middlesex Hosp J 1955;55:188-9.
• 23 Bose B. Honey or sugar in treatment of infected wounds? Lancet 1982;1:963.
• 24 Green AE. Wound healing properties of honey. Br J Surg 1988;75:1278.
• 25 Hussain S, Ferguson C. Best evidence topic report: Silver sulphadiazine cream in burns. Emerg Med J 2006;23:929-32.