Local Treatment of Chronic Wounds in Patients With
Peripheral Vascular Disease, Chronic Venous Insufficiency and Diabetes by Dr.
med. Mike Rüttermann, Dr. med. Andreas Maier-Hasselmann, Brigitte Nink-Grebe,
Marion Burckhardt in volume 3/2013
The data regarding different treatments for wounds are still
disappointingly scant. No grade B recommendations are available for wound care
products, and grade A seems completely out of the question! A grade B
recommendation exists only in favor of hydrogel, hyperbaric oxygenation in
ulcers that are beyond treatment in diabetic foot syndrome, and integrated
care. In view of the many patients and the vast market in wound care products,
this is sobering. I was therefore all the more surprised at the recommendation
not to use honey for chronic wounds (the context was really generally that of
chronic wounds) because honey resulted in more pain in a single study of venous
ulcers. Why was a special scenario (venous ulcers) generalized to include all
chronic wounds?
Years of experience with manuka honey in patients with
diabetic foot syndrome have shown that pain usually does not constitute a
problem in these wounds owing to the comorbid polyneuropathy. I would have
welcomed a fact-based recommendation, differentiated by evidence level (which
exists for a negative recommendation only for venous ulcers). Numerous small,
qualitatively moderate to poor studies of honey treatment in diabetic foot
syndrome have shown mostly promising results, which are entirely consistent
with my own observations. Obviously, high-quality randomized controlled studies
of honey treatment in diabetic foot syndrome are absolutely necessary and
desirable. But until these have been conducted and reported, the treatment of
the diabetic foot syndrome with honey provides an efficient, cost-effective
variant with a poor evidence base. This, however, is also the case for all
other wound treatments.
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