Katherine Morrison's List: Burn and Wound Healing

• Aloe vera is often recommended as a treatment for minor burns; however, no evidence exists to support this claim, and some studies have actually found it ineffective.^6,7
• there is some evidence that hospitalized individuals with severe burns may benefit from nutritional support with certain supplements, including  ornithine alpha-ketoglutarate (OKG),  arginine,  zinc,  copper,  selenium, and  dehydroepiandrosterone (DHEA).^22-25 

• Burn injury to the integument causes cellular death, capillary damage in varying degrees and coagulation of proteins. The loss of protective function of the skin as a barrier to micro-organisms results in infection. Immediately after burns the wound is sterile, but within a very short time bacteria contaminating the wound surface begin to multiply and proliferate in the area of the burn wound leading to extensive bacterial colonization.
• management of the burn wound still remains a matter of debate and an ideal dressing for burn wounds has not been discovered.[2]
• Patients (n=78) of both sexes admitted in the burn unit of M.Y. Hospital, Indore, over a period of 2 years (June 2006 to June 2008) with age group between 10 and 50 years and with first and second degree of burn having burn area less than 50% of TBSA total body surface area) were included in a randomized comparative study.
• patients were randomly attributed into two study groups; Honey group and SSD group, and following data were recorded:
  • Registration data: age, sex, residence, level of education, occupation, marital status.
  • Time of admission: time elapsed since burn and taken to reach the hospital.
  • Investigations: CBC, RBS blood urea, serum creatinine, serum electrolyte.
  • Clinical assessment of the wound: site, affected body surface area, degree, depth, presence or absence of slough, culture sensitivity every seventh day, any additional treatment, outcome.
  • Chronological data: dates of admission and discharge.
• Thus average duration of healing of patients in the honey group was significantly lower than that of patients in the SSD group.
• Among patients treated with honey dressing, wound swab culture became negative in less than 7 days, in 62.5%, 50% and 50% of total number of patients reporting in 2-8 hours, 9-24 hours and after 48 hours, respectively [Table 4].
• Among patients treated with SSD dressing, none of the patients' wounds became sterile in less than 7 days.
• Out of a total 37 patient treated with honey dressing, 30 (81%) had complete recovery.
• In the SSD group, out of 32 patients presenting within 24 hours, only 12 patients had complete recovery and out of a total of 41 patients, only 15 (37%) achieved complete recovery.
• When used topically (as for example, a wound dressing), hydrogen peroxide is produced by dilution with body fluids. As a result, hydrogen peroxide is released slowly and acts as an antiseptic.
• The antibacterial activity of honey is mainly due to inhibins in honey. These inhibins consist of hydrogen peroxide, flavinoids, and phenolic acids, plus many other unidentified substances.[7,8]
• Honey dressing decreases the average duration of healing as compared to the SSD dressing.
• Honey is reported to cause no tissue damage and appears to actually promote the healing process.
• Similar results were found in the previous study done by Subrahmanyam,[20] where 84% and 72% showed satisfactory epithelialization by the seventh day with honey and SSD dressing, respectively.
• Epithelialization occurred in 100% and 84% of the patients by the 21st day in wounds treated with honey and SSD dressing, respectively.
• Histological evidence of reparative activity reached 100% by 21 days with the honey dressing and 84% with SSD.[20]
• honey dressing improves wound healing by rendering it sterile in lesser duration of time, wounds thus treated have a better outcome in terms of hypertrophic scarring and post-burn contractures; this is due to the fact that early healing mitigates the need for debridement at when compared to SSD dressing. Hence, Honey dressing is a better option for dressing in burns, in terms of decreased morbidity, economy, patient well-being and speedy rehabilitation.

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• One study in infected postoperative wounds compared honey with antiseptics plus systemic antibiotics.
• The number needed to treat with honey for good wound healing compared with antiseptic was 2.9 (95% confidence interval 1.7 to 9.7)
• Five studies in patients with partial thickness or superficial burns involved less than 40% of the body surface.
• Comparators were polyurethane film, amniotic membrane, potato peel and silver sulphadiazine.
• The number needed to treat for seven days with honey to produce one patient with a healed burn was 2.6 (2.1 to 3.4) compared with any other treatment and 2.7 (2.0 to 4.1) compared with potato and amniotic membrane.
• For some or all outcomes honey was superior to all these treatments. Time for healing was significantly shorter for honey than all these treatments. The quality of studies was low.
• Confidence in a conclusion that honey is a useful treatment for superficial wounds or burns is low. There is biological plausibility.
• With honey, we also need to be aware that it is a natural product, and that those characteristics associated with wound healing may be affected by species of bee, geographical location and botanical origin, as well as processing and storage conditions.
• Some basic knowledge of the importance of these issues is necessary before trials could begin. While these trials would be relevant to industrialised countries to compare honey with conventional treatments, it would be important to conduct them in the less developed world where cost and availability are the key issues.

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• It is traditional teaching and practice that silver sulfadiazine (SSD) is the agent of choice for the outpatient management of minor or partial-thickness burns. Published reports show, however, that other methods of outpatient burn management are superior.
• it is difficult to find results of any trial in which SSD is the preferred treatment.
• Honey, an inexpensive, simple, and natural substance, has been used since ancient times to treat burn wounds
• By day 21, wound healing was complete in all of the patients in the honey-treated group and in only 21 of the 25 patients in the SSD-treated group (p < 0.05).
• Subrahmanyam's studies were not conducted in an outpatient setting, and the TBSA of partial-thickness burns was as much as 40%, these results suggest that honey may be a simple, inexpensive, alternative—and probably superior—dressing to use when treating minor burns.
• Compared with those in the SSD-treated group, burns in patients treated with Duoderm healed faster, showed better appearance after healing and better repigmentation, required fewer and less elaborate dressing changes, and were less costly to treat.
• Patients with burns treated with Biobrane healed faster (10.6±>0.8 days vs 15.0±1.2 days, p < 0.001), had less pain, and incurred lower treatment costs.
• The traditional idea that SSD cream is the first-line treatment for minor burn wounds is archaic. Other methods are better and more cost effective. Evidence exists that the use of SSD may place patients at increased a risk of developing neutropenia, erythema multiforme, crystalluria, and methemoglobinemia.³

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