Mohanakrishna Meka.

Comparison of Conventional Normal Saline Dressing and Honey Dressing in the Management of
Chronic Non Healing Ulcers. IAIM, 2018; 5(3): 113-119.

Original Research Article

Comparison of Conventional Normal Saline

Dressing and Honey Dressing in the
Management of Chronic Non Healing
Ulcers
Mohanakrishna Meka*
Assistant Professor, Department of Surgery, Chalmeda Anand Rao Institute of Medical
Sciences, Karimnagar, Telangana, India
*
Corresponding author email: vanisu1990@gmail.com

International Archives of Integrated Medicine, Vol. 5, Issue 3, March, 2018.

Copy right © 2018, IAIM, All Rights Reserved.
Available online at http://iaimjournal.com/
ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)
Received on: 09-01-2018 Accepted on: 17-02-2018
Source of support: Nil Conflict of interest: None declared.
How to cite this article: Mohanakrishna Meka. Comparison of Conventional Normal Saline Dressing
and Honey Dressing in the Management of Chronic Non Healing Ulcers. IAIM, 2018; 5(3): 113-119.

Abstract

Background: This study was to show the advantage of Honey dressing over conventional saline
dressing in the management of chronic non healing ulcer.
Materials and methods: This was an open study comparing conventional normal saline dressing and
honey dressing in the management of chronic non healing ulcers done during July 2014 to June 2015
in general surgical wards of government TD medical college, Alappuzha.
Results: Factors assessed include average hospital stay, culture sterility pre and post dressing, their
outcome plan (discharged, amputated or grafted), whether diabetes and vascular compromise has
altered the results in two groups etc. As in evidence with ancient literature and studies in modern
literature it was proved that irrespective of age, sex, distribution of diabetes and vascular compromise
in Doppler; honey dressing was significantly advantageous over conventional normal saline dressing
in terms of culture sterility, better outcome plan as well as less stay in hospital.
Conclusion: The honey dressing is a better alternative to conventional normal saline dressing which
can also pave way for decrease in antibiotic resistance.

Key words

Normal Saline dressing, Honey dressing, Ulcers.

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Mohanakrishna Meka. Comparison of Conventional Normal Saline Dressing and Honey Dressing in the Management of
Chronic Non Healing Ulcers. IAIM, 2018; 5(3): 113-119.

Introduction Burkholderia cepacia to the list of susceptible

A chronic non healing ulcer is one of the most bacteria [1].
common cause of admission in the surgical ward,
most common causes being Diabetes mellitus, Aim and objectives
POVD, Traumatic and Venous ulcer. Most  To study the advantage of Honey
commonly the lower extremity is affected. dressing over conventional saline
dressing in the management of chronic
Nearly 1% of the adult population is affected by non healing ulcer.
this morbidity, of which 12% of chronic non  To prove that the duration with which a
healing ulcer foot go for amputation. Once chronic non healing ulcer will become
patient is amputated chance of developing ulcer bacteriologically sterile and develop
in the opposite extremity increases. healthy granulation tissue is less with
honey dressing compared to
Even if the limb is saved, prolonged use of conventional saline dressing.
antibiotics, hospital stay, repeated wound
debridement add to the physical, mental and Materials and methods
financial trauma of the patient. In addition, the
Study was conducted among patients admitted
emergence of antibiotic resistant strains are
with chronic non healing ulcers in male and
occurring day to day which add to the cost of the
female general surgical wards of Govt. T.D
treatment. Still the line of management of
Medical College, Alappuzha which is a tertiary
chronic non healing ulcer is in most of our
care centre for one year extending from July
hospital is repeated wound debridement, saline
2014 to June 2015.
washing, dry to moist gauze dressing and
antibiotics.
Patients who meet the inclusion criteria was
selected during the study period. For the first 6
Wagner Grading System for Diabetic Foot
months of study Saline dressing was given. For
Infections
the next 6 months of study Honey dressing was
0 – Intact Skin
given.
1- Superficial ulcer of skin or subcutaneous
tissue
Inclusion criteria
2- Ulcers extend into tendon, bone, or capsule
All Patients of age group 13-80 years included in
3 - Deep ulcer with osteomyelitis, or abscess
this study are classified according to the grade of
4 - Gangrene of toes or forefoot
ulcer by Wagner classification and EPUAP
5 - Midfoot or hindfoot gangrene
classification for pressure sores
 All grades included except those in
Though honey has been mentioned to have a
which gangrene has already occurred.
curative role in ancient literature, only recently
 Diabetic ulcer
it has been integrated into modern medical
 Traumatic ulcer
practice. The antibacterial property of honey
was first recognized in 1892 by Van Ketel. In  Venous ulcer
1919 the antibacterial effect of honey was  Ulcer due to POVD
proven in laboratories. In vitro studies have Exclusion criteria
shown that active honey is bactericidal against  Fistulas to organs or cavities
strains of antibiotic resistant bacteria isolated  Discharging sinus from bone
from infected wounds such as MRSA,  Malignancy
vancomycin-resistant enterococci and  Exposed blood vessels
 Tuberculous ulcer

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Mohanakrishna Meka. Comparison of Conventional Normal Saline Dressing and Honey Dressing in the Management of
Chronic Non Healing Ulcers. IAIM, 2018; 5(3): 113-119.

Study procedure local hospital and asked to review later.

Due clearance was obtained from the research Amputation was done in those patients
and ethical committee and informed written who had spreading infection with a
consent from the patients after explaining to nonviable limb.
them about the procedure and purpose of this  Duration of hospital stay.
study. On admission Pus C&S was taken for both  Whether there is any difference of
groups and Arterial Doppler study to assess the outcome in different distribution of
vascularity of the limb was done in both groups. grades of ulcer.
X ray of the affected region was taken to rule out  Whether there is any difference of
osteomyelitis. Wound debridement was done in outcome in patients with vascular
both study groups. compromise which is found out by
Doppler ultrasound.
For first 6 months, patients were given  Whether there is any difference of
conventional saline dressing i.e. cleaning the outcome in patients with diabetes
ulcer with saline, debridement if abundant slough mellitus.
was present, covering the wound with sterile
surgical pads after cleaning the surrounding skin Clinical data obtained from the study was
with povidone-iodine. Alternate day cleaning and analysed using SPSS software. Mean, median
dressing was done. Oral or parenteral antibiotics and mode was calculated for categorical data.
were also given. Next 6 month selected patients The tests of significance used include students t
were given Honey dressing. Honey poured over test and chi square test. Level of significance is p
the ulcer to fill three quarter of the depth. Gauze value < 0.05.
was placed over the ulcer, then dry sterile
surgical pad was applied after cleaning the Results and Discussion
surrounding area with povidone iodine.
Age distribution of patients included in study
Antibiotics were also given orally or parenterally
People included in the study were categorized
and alternate day dressing was given. Honey
under 4 groups with regard to age i.e., those who
(government supply bottled honey) used in this
are, < 40 years, 40-49 years, 50-59 years, >60
study is sterilized by heating at 650 Celsius for 5
years. 94% of patients were between the age
mins. It was obtained from College of
group 40-59 (Graph - 1).
Agriculture, Vellayani.

Total 50 patients were included in the study out

Outcome was assessed at the end of 1st week in
of which 27 patients received honey dressing and
both groups and factors assessed include Pus c &
23 patients got normal saline dressing (Graph -
s (for presence or absence of organism), Nature
2).
of discharge (whether purulent or serous),
Appearance of healthy granulation tissue.
In none of these groups the difference in number
The factors used in comparison of saline dressing
of patients between honey dressing and saline
and honey dressing include:
dressing were statistically significant (p
 Pus culture before and after dressing.
value>0.05).
 Outcome plan-whether patient was
discharged, amputated or grafted.
Mean age of patient included under honey
Grafting was done in patients with
dressing was 60.29 and Mean age of patient
healthy granulation tissue and minimal
dressed with normal saline is 59.34.
serous discharge. In those patients whose
wound culture was sterile but not fit for
Among these 50 patients, 28 patients were male
grafting were discharged for dressing in
(56%) and 22 patients females (44%). Those who

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Mohanakrishna Meka. Comparison of Conventional Normal Saline Dressing and Honey Dressing in the Management of
Chronic Non Healing Ulcers. IAIM, 2018; 5(3): 113-119.

were given honey dressing included 15 males both before dressing and 7 days after dressing. It
and 12 females. Normal saline group included 13 was observed that honey dressing turned 92% of
males and 10 females. Gender differences in both cultures sterile. Chi square value was calculated
groups were also proven to be statistically as 35.9 and p value 0.0001. Hence the effect of
insignificant with p>0.05. honey dressing on turning unsterile cultures
sterile was proved to be highly significant (Table
Culture sterility- pre and post honey dressing – 1).
Swab was taken from ulcer site and was sent for
culture and sensitivity to our microbiology lab,

Graph - 1: Age distribution of patients included in study.

Graph - 2: Gender distribution of patients included in study.

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Mohanakrishna Meka. Comparison of Conventional Normal Saline Dressing and Honey Dressing in the Management of
Chronic Non Healing Ulcers. IAIM, 2018; 5(3): 113-119.

Table - 1: Culture Sterility Pre-Post-Dressing in Honey Dressing Group.

Culture sterility in honey dressing group Pre dressing Post dressing

Sterile 3 25
Unsterile 24 2
Total 27 27

Table - 2: Analysis of outcome of honey and saline dressing.

Outcome Normal saline Honey dressing Total
Discharge 13 6 19
Split skin graft 4 17 21
Amputation 6 4 10
Total 23 27 50
 (chi square=10.77,p value=0.004)

Table - 3: Comparison of duration of hospital stay.

Duration of hospital Normal saline group Honey dressing group Total
stay (in days)
7 to 13 0 1 1
14 to 21 2 3 5
22 to 28 5 16 21
29 to 35 9 6 15
36 to 50 7 1 8
Total 23 27 50

Table - 4: Distribution of different grades of ulcer in study population.

Grade of ulcer Saline dressing Honey dressing Total
Grade 1 1 2 3
Grade 2 10 11 21
Grade 3 10 8 18
Grade 4 2 6 8
Total 23 27 50

Table - 5: Doppler findings in study population.

Doppler finding Saline dressing Honey dressing Total
Normal 11 17 28
Vascular compromise 12 10 22
present
Total 23 27 50

Table - 6: Distribution of diabetes mellitus in study population.

Saline dressing Honey dressing Total
DM+ 12 11 20
DM- 11 16 30
Total 23 27 50

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Mohanakrishna Meka. Comparison of Conventional Normal Saline Dressing and Honey Dressing in the Management of
Chronic Non Healing Ulcers. IAIM, 2018; 5(3): 113-119.

Analysis of outcome of honey and saline Distribution of different grades of ulcer in

dressing (Table - 2) study population (Table – 4)
Patients were categorized under the three In saline dressing group, Only 1 out of the total
probable outcomes: 23 belonged to grade 1 ulcer, 10 patients grade 2,
 Discharged and asked to review later another 10 patients grade 3 and 2 among them
 Split skin grafting done during their had grade 4 ulcer. In honey dressing group 2 out
hospital stay of the total 27 patients had a grade 1 ulcer;11
 Those who ended up in amputation. patients were grade 2;8 patients had grade 3 ulcer
and 6 patients grade 4.Majority of the patients
63% of patients who were dressed with honey belonged to grade 2 and 3 ulcer in both study
could be grafted during their hospital stay where groups. This difference in distribution of grades
as only 17% of normal saline dressing group of ulcer in both groups were proven to be
could be grafted. This difference was proven to statistically insignificant with a p value >0.05.
be statistically significant with a p value of 0.004 (Chi square=2.29, p value=0.512).
(chi square=10.77), thus confirming that honey
dressing helps in early grafting of the patient and This confirms that better outcome in honey
hence superior to conventional saline dressing. dressing like less mean duration of hospital stay
and possibility of early grafting is not affected by
Analysis with regard to duration of hospital the grade of ulcer. Thus superiority of honey
stay (Table - 3) dressing over conventional saline dressing is
Average duration of hospital stay in those proved irrespective of grade of ulcer.
dressed using normal saline was found to be 31.3
with standard deviation 6.5 and median being 30 Doppler findings in study population (Table –
and mean duration in those dressed with honey 5)
was found to be 25.77 with standard deviation In saline dressing group, Out of the total 23
5.27, median being 26. Difference in average patients, 11 had a normal Doppler study whereas
duration of hospital stay in both groups was 12 patients had evidence of vascular
proven to be highly statistically significant with a compromise. In honey dressing group, 17 among
p value of 0.000934 (t value=3.29). the 27 patients had normal Doppler scan whereas
Duration of hospital stay was further divided into 10 had evidence of vascular compromise
 7-13 days according to Doppler. 52% of saline dressing
 14-21 days group and 37% of honey dressing group had
 22-28 days evidence of vascular compromise in Doppler
 29-35 days study. When tested using chi square test, it was
found that the difference in number of vascular
 >35 days.
compromised patients in both study groups was
not statistically significant with a p value>0.05
Among these groups 21 of total 50(42%)
(chi square=1.15, p value=0.28). This proves that
belonged to 22-28 days group. Another
honey dressing is superior to saline dressing
observation was that only 1 among the honey
irrespective of the factor that they are vascular
dressing group stayed for more than 35 days;
compromised or not.
whereas 7 among the normal saline group stayed
in hospital for more than 35 days. This difference
Distribution of diabetes mellitus in study
in both groups was studied using chi square test
population (Table – 6)
and was found to be statistically significant with
Among 50 patients included in the study, 20
a p value of 0.018 (Chi square value=11.8).
patients were diabetic.47.8% of patients in whom
saline dressing was used and 59.2% of patients in
whom honey dressing was used were non

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Mohanakrishna Meka. Comparison of Conventional Normal Saline Dressing and Honey Dressing in the Management of
Chronic Non Healing Ulcers. IAIM, 2018; 5(3): 113-119.

diabetic. This difference in distribution of  Anti-inflammatory activity rapidly

number of diabetic patients were proved not reduces pain, oedema, and exudate and
significant with p value>0.05. minimises scarring.
The honey dressing is a better alternative to
Honey has been proven to have significant conventional normal saline dressing which can
antibacterial properties and is a useful constituent also pave way for decrease in antibiotic
in wound and burn care [2]. It contains diastase, resistance.
invertase and glucose oxidase. The antibacterial
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