Using Leptospermum Honey to Manage Wounds Impaired by Radiotherapy: A Case Series
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Two weeks later, she underwent a left mastectomy and axillary clearance. Between May and August 2004 following her operation, she underwent chest wall radiotherapy. By August 2004, Ms. K’s mastectomy wound failed to heal at the lateral end of the scar. Visiting district nurses redressed the wound with alginate packing. In December 2004, the lateral part of Ms. K’s wound was excised to debride the wound and encourage healing.
At her January 2005 outpatient appointment, Ms. K’s wound still had failed to heal. The area exhibited localized redness and maceration caused by the wound exudate. A small cavity approximately 3 cm in depth was noted along with two smaller superficial broken areas along the original suture line (see Figure 4a). A honey-soaked hydrofiber rope was loosely packed into the wound and honey applied along the suture line. A no-sting barrier film was applied to the periwound area and an adhesive foam dressing was applied to the wound. Initially, Ms. K was advised to remove the dressing and shower daily. As the wound improved, dressing change frequency was reduced.
After 2 weeks, Ms. K’s wound was substantially smaller (see Figure 4b). After 4 weeks of honey treatment, the cavity was almost closed (see Figure 4c) and, after a little more than 6 weeks of treatment the wound healed and localized redness subsided (Figure 4d). Table 1 summarizes patient treatment information.
Four patients with radiotherapy-impaired wounds and compromised skin received care that included medical grade honey. In all cases, a change from conventional dressings to the topical application of honey was followed by a noticeable improvement in healing. It is not possible to report complete healing in all examples because Patient 1 (Mr. G) died and Patient 2 (Ms. H) was lost to follow-up but the latter reported a noticeable reduction in pain once honey was introduced. No adverse events were observed and even though Patient 3 (Ms. J) had type 2 diabetes, daily honey applications to her wound had no adverse effect on her blood sugar levels. All patients readily accepted honey as a dressing for their wounds.
Radiation damage to healthy tissue begins immediately after radiation exposure but clinical and histological features may not be apparent for weeks, months, or years after treatment. In head and neck cancer patients, radiotherapy has been shown to affect not only skin, but also mucosa, subcutaneous tissues, bone, and salivary glands.23 Skin and oral mucosal reactions are not uncommon but because the extent of the damage is related to the radiation regimen implemented, as well as genetic and personal factors, they are not easily predictable.24 A prospective, descriptive, correlational study with repeated measures25 of 126 women undergoing radiotherapy for breast cancer noted that predictive factors for developing severe skin reactions included smoking, poor lymphatic drainage, weight and/or large breast size, and a history of breast cancer; however, as age increased, the risk of severe skin reaction decreased.
The importance of choosing suitable dressings and topical treatments for wounds in patients undergoing radiation therapy is recognized, despite the absence of empirical evidence.12 Currently, the chronic irradiated wound is cared for in a manner similar to other chronic wounds because the exact microenvironment of the irradiated wound remains undefined.26 According to a review,26 adequate debridement followed by a use of a dressing that promotes granulation tissue formation have been recommended; adhesive dressings are avoided to prevent epithelial injury.
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