MEDICAL CHESTNUT HONEY ESTABLISHES A MOIST ENVIRONMENT IN THE WOUND DUE TO ITS HIGH SUGAR CONTENT, WHICH CAUSES OSMOTIC ACTIVITY.
MOISTURE BALANCE IN THE WOUND IS ALSO AFFECTED BY THE MATERIAL OF THE WOUND DRESSING IMPREGNATED WITH HONEY.
MAINTAINS MOIST ENVIRONMENT
In the process of wound healing, it is crucial to establish a moist environment as soon as possible and to promote healing processes by using an appropriate dressing. Wounds have been proven to heal two times faster in a moist environment. The main reason is maintaining of the optimal temperature and moisture in the wound, easier and faster migration of newly formed cells, and consequently reduced scarring.
With its osmotic action, honey creates a moist environment in the wound that is favourable to wound healing. Chestnut honey has an ideal ratio between glucose and fructose and therefore just the right viscosity to cover the wound bed completely. Honey, covering the wound, protects it from external factors and infection and creates a moist environment in it. Additionally, the pull of the exudate from the wound (i.e., osmotic pressure) due to the high sugar content in honey and material of the dressing impregnated with honey also contribute to maintaining a moist environment. Medical chestnut honey stimulates local immune response in the wound.
The combination of these effects of honey in the wound leads to shortening of the inflammatory phase, reduced microbial load, maintaining the appropriate level of growth factors, and accelerated collagen synthesis and epithelialization from the edges of the wound.
SUGAR IN HONEY TRIGGERS AN OSMOTIC EFFECT THAT INCREASES PERFUSION, WHICH SOFTENS AND “DISSOLVES” NECROTIC TISSUE IN THE WOUND.
PEROXIDE ACTIVITY ACTIVATES PROTEASES THAT DECOMPOSE NECROTIC TISSUE IN THE WOUND.
Chronic wound treatment is often lengthy, but also depends on the aetiology of the wound, the clinical picture, and the patient’s general health status. In treating acute and chronic wounds, the removal of dead tissue (debridement) is extremely important. In the process, colonized bacteria and dead cells that inhibit healing are also removed.
Debridement is a very important part of CLEANING (which, in addition to removing necrotic tissue, also includes the removal of impurities, foreign material, and microbes) that prepares the wound for healing. Only a clean wound allows good contact of the dressing with the wound bed.
PROMOTES DEBRIDEMENT AND CLEANING
VIVAMEL CLEANS THE WOUND AND PROMOTES HEALING
Dead tissue acts as a physical barrier that prevents contractions in the wound and growth factor activity. Continuous debridement should be ensured throughout the whole wound healing process. Honey as a saturated sugar solution causes osmosis and increases perfusion in the wound. This softens and dissolves the nonvital tissue without pain. The osmotic activity of honey in the wound massively attracts macrophages and lymphocytes and thus stimulates a local immune response.
If there is a lot of necrotic tissue, it is advisable to first resort to a more radical method (e.g., surgical removal), and then use wound dressings to remove the remaining dead tissue and exudate from the wound. Medical chestnut honey is an effective wound cleanser and is truly exceptional – in addition to autolytic, it also provides proteolytic debridement.
The main mechanism of autolytic debridement is osmosis. Due to its high sugar content, honey activates the osmotic effect in the wound, which increases the flow of fluids in the tissue and triggers an immune response. Increased fluid flow softens the dead, nonvital tissue without pain. Osmosis also causes the pull of the fluid from the tissue, which reduces swelling and pain. Increased blood circulation in the tissue ensures a constant supply of oxygen and food for the newly formed cells and defence cells that clean the wound and defend it against infection.
Stimulated proteolytic debridement is another proof of how exceptional medical chestnut honey is. It is activated by the enzyme glucose oxidase. In mature honey, the enzyme is inactive and is activated when fluid is absorbed by honey. It then catalyses a reaction in which hydrogen peroxide is formed. This activates proteases that break down necrotic tissue. Inflammation, oedema, and pain are reduced.
Only a cleaned wound bed enables uninterrupted healing. The dissolved honey creates a moist environment in the wound, which is the most optimal for healing.
Chronic wounds are most often a result of prolonged inflammatory processes and infections that the body cannot eliminate on its own. Other associated diseases or improper approach to wound care may also be a contributing factor. Inflammatory processes and infections in the wound need to be soothed or even prevented.
Honey with its high sugar content causes a strong pull of fluids from the wound (i.e., osmotic pressure). Osmosis increases blood flow to the wound and thus the progression of defence cells that break down dead tissue. Osmosis is also the reason for the increased drainage of the wound exudate, which reduces inflammation (reduces swelling and pain).
The acidic pH of honey has not only antimicrobial but also a direct anti-inflammatory effect as it inhibits the activity of proteinases. Too many matrix metalloproteinases (MMPs) slow down the healing process as they cause the destruction of growth factors in the tissue.
Wound exudate dilutes the honey and thus activates the enzyme glucose oxidase that triggers a chemical reaction in which hydrogen peroxide is released slowly and in low concentrations. H2O2 activates enzymes that also reduce inflammation in the wound.
The reduction of local inflammation in the wound area is not only the result of the antibacterial activity of honey, but also of its direct anti-inflammatory action. The latter consequently reduces the amount of excretion from the wound and thus oedema, which results in faster healing of the wound. Simultaneously, pressure on the nerve endings is reduced, resulting in reduced pain. The application of medical honey to the tissue also reduces the secretion of prostaglandins – hormones that cause the development of inflammation and pain.
Chestnut honey is rich in antioxidants that also have an anti-inflammatory effect: flavonoids, phenolic acids, the amino acid proline, and ascorbic acid neutralize free radicals and thus restore the oxidative balance in tissues and consequently reduce inflammation in the wound. Antioxidants also act antimicrobially and thus reduce infection in the wound.
Analgesic effect: with the reduction of inflammation in the wound, the nerve endings are less irritated, so the pain decreases. After the application of Vivamel, the osmotic activity and pH of honey can cause a short-term, transient pain that is present during the first two or three dressing changes. It usually disappears within two to three hours after honey is applied.
Antioxidants are very important in wound healing. They protect cells from the effects of oxygen free radicals that form in the wound during the inflammatory process.
During the process of inflammation, free radicals or reactive oxygen species (ROS) are formed from the oxygen within the respiratory chain in mitochondria as well as in leukocytes. The cytotoxic effect of ROS on bacteria is known but in the case of high concentrations during oxidative stress, they also have a destructive effect on cellular structures. The presence of antioxidants, which inhibit the excessive production of ROS, is crucial for the survival of cells.
The antioxidant activity of honey is based on the presence of both water-soluble and lipid-soluble antioxidants. Therefore, honey develops antioxidant activity in various cellular environments and restores oxidative balance in the tissue.
Among antioxidants in chestnut honey, flavonoids and polyphenols stand out. Their antioxidant activity is the result of dual action. Primarily, they fight against microorganisms and thus reduce infection in the wound. Simultaneously, they also directly reduce ROS and consequently reduce inflammation.
Medical chestnut honey is also exceptional for its proline content, which is also a powerful antioxidant.
The antimicrobial activity of medical chestnut honey is long-lasting, intense, and effective.
The most important properties of medicinal chestnut honey that have an impact on antimicrobial activity are high sugar content, low water content, acidic pH of honey, high content of the enzyme glucose oxidase and kynurenic acid, and antimicrobial peptide content.
Due to its physicochemical properties, honey creates a very hostile environment for microbes in the wound. The high sugar content dehydrates the bacteria, and the acidic pH of honey creates an environment in which they do not have the right conditions for growth and development. Honey’s osmotic effect on bacteria inhibits their growth, which indirectly promotes healing. Honey is hygroscopic, which means that it draws moisture from the environment. This is how it dehydrates bacteria and destroys them, while at the same time removing unpleasant odours from the wound.
The peroxide antimicrobial effect of honey is based on the activity of the enzyme glucose oxidase. The enzyme is secreted into honey during maturation by the bee’s hypopharyngeal gland. The enzyme glucose oxidase triggers a reaction in which hydrogen peroxide and gluconic acid are formed. Hydrogen peroxide is released slowly and in very low concentrations. Gluconic acid (the predominant acid in honey, largely responsible for the low pH of honey) further lowers the pH value. Together, they significantly contribute to the antimicrobial activity of honey, lowering the pH, and further worsening the conditions for growth and reproduction of bacteria.
Kynurenic acid, which is uniquely present in chestnut honey, destabilizes biofilm and prevents its formation. Biofilm is almost always present in wounds older than four weeks.
Non-peroxide antimicrobial mechanisms are based on the activity of various components added to honey by a bee or a plant. Antimicrobial peptides (AMPs) that are present in medical chestnut honey – the most important among them being defensin-1 (also known as royalisin) – are part of the innate immune system of organisms, including insects. These AMPs have an antimicrobial effect on a wide range of bacteria.
DESTABILIZES BIOFILM AND PREVENTS ITS FORMATION
In more than 99% of chronic wounds, bacteria create a biofilm – they form a special polysaccharide coating that protects them from external influences, antibiotics, and the immune response of the host. Bacteria in the biofilm are well organized, therefore, removing biofilm from chronic wounds is difficult. Therapies of the future include wound treatment with agents that affect the microbiome in the wound, inhibit molecules that bacteria use for intercellular communication (i.e., quorum sensing – QS), and degrade the polysaccharide matrix of the biofilm. The risk of biofilm formation is significantly reduced if debridement is performed regularly.
Wound dressings with medical chestnut honey have proven successful in combating biofilm.
In nature, bacteria can be free-living, in planktonic form, but more often they connect and form biofilm. Planktonic bacteria enter a favourable environment (they need a moist environment), attach themselves to a surface in a few seconds or minutes, and form a dome-shaped polymer matrix (made of polysaccharides, proteins, and nucleic acids), which protects them from external influences, antibiotics, and the immune response of the host. Under the dome, permeable to oxygen and nutrients, they reproduce and expand into colonies. They release decomposition products into the environment through the water channels crisscrossing the colony.
Research has confirmed that chestnut honey destabilizes and prevents the formation of biofilm most successfully. Its exceptionally high value of kynurenic acid inhibits the communication between bacteria in the biofilm. Additionally, due to its high sugar content, honey also promotes autolytic debridement, which reduces the microbial load greatly. Effective removal of microbial load, including biofilm, has been proven to promote wound healing.
STIMULATES GRANULATION AND EPITHELISATION
Only when the wound is cleaned can the formation of new tissue begin in full – granulation and epithelialization. Granulation can simply be described as filling the wound with tissue from the inside/bottom. Throughout this phase, collagen synthesis takes place and extracellular matrix is formed. Reddish nodules called the granulation tissue form in the wound. Initially it is pale but turns red due to the growth of capillaries (accelerated angiogenesis also takes place). When the wound is filled with granulation tissue, it begins to epithelialize from the edges. In the epithelialization phase, the processes of proliferation and migration of epithelial cells – keratinocytes – take place; the wound starts to close. Keratinocytes, the predominant cells of the epidermis, smoothly migrate from the edges to the middle of the wound in a moist environment created by honey.
Uninterrupted cell proliferation and migration promote healing with less or no scarring.
MEDICAL CHESTNUT HONEY STIMULATES GRANULATION AND EPITHELISATION WITH MULTIPLE MECHANISMS:
- the content of potassium, calcium, zinc, manganese, and proline is crucial for collagen synthesis and extracellular matrix formation;
- high sugar content in the wound activates the osmotic effect, increasing perfusion in the tissue, which ensures the penetration of macrophages (the source of growth factors), enough fibroblasts that synthesize collagen, and a smooth cell migration;
- acidic pH of chestnut honey lowers the activity of metalloproteinases, which is beneficial for collagen formation, stimulates the release of oxygen from haemoglobin, and thus accelerates cell proliferation;
- enzyme glucose oxidase: hydrogen peroxide, formed in a reaction oxidized by the enzyme glucose oxidase, promotes angiogenesis and connective tissue formation;
- antioxidants inhibit free radicals in the tissue, thus shortening the inflammation phase in the wound and promoting healing, closing of the wound.
REDUCES UNPLEASANT ODOUR
Infected wounds are heavily populated with bacteria, the most common being E. faecalis, S. aureus, E. coli and P. aeruginosa. In the wound, the conditions for their development are favourable, there are enough nutrients and moisture, the temperature is constant and appropriate. Due to the infection, the wound heals more slowly, it can also have an unpleasant odour. This is a significant problem for many patients with chronic wounds, as it forces them into social exclusion, stigmatizes them, and robs them of human dignity.
Unpleasant odour of the wound can be effectively reduced by reducing the infection in it. Yet again, medical chestnut honey demonstrates its enviable properties. It successfully reduces wound infection due to its high content of sugar and kynurenic acid, its acidic pH, and the enzyme glucose oxidase.
Medical chestnut honey additionally reduces unpleasant odours as it diverts bacteria to start feeding on sugars. As a metabolite of their metabolism, lactic acid is formed. It does not have an unpleasant smell and creates an environment hostile to microbes.
Medical chestnut honey eliminates unpleasant odours and allows people with wounds to live a life without stigma.
WOUND CARE FOLLOWING THE
MODERN AND COMPREHENSIVE APPROACH TO WOUND TREATMENT
In wound healing, it is crucial to shorten the healing time, reduce the number of dressings, and prevent possible complications.
Before a wound healing process can start, the wound needs to be evaluated and then treated systematically. The TIME CONCEPT is a modern and most popular approach to local wound care in the world. TIME leads us step by step through wound assessment and achieving the objectives: T as tissue, I as infection and inflammation, M as moisture, and E as edges, epithelialization. When determining therapeutic strategies in local wound care, we decide based on the assessment of the condition in four steps.
First step is the assessment of the predominant tissue in the wound. Depending on the predominant tissue, we decide whether the goal will be to remove the dead tissue or to promote granulation and epithelialization. Next, the degree of inflammation and signs of infection should be assessed. Inflammation and infection are related to the amount of exudate, so in the third step we need to determine how to establish a moist environment favourable for healing. Such an environment will stimulate proliferation; assessment of granulation and epithelialization progress is the last step.
When assessing the wound exudate, we determine whether the wound is dry and therefore needs additional hydration or the amount of exudate is too high and needs to be regulated. Usually, the regulation of high amounts of exudate is associated with a reduction of inflammation and infection in the wound.
With the right approach to wound care, the healing process progresses spontaneously, the wound heals and closes from the edges. If this is not the case, it is necessary to repeat the step-by-step assessment following the TIME concept and determine where it went wrong.
Through analysis, testing, and clinical studies, we have proven that the physical properties, enzymes, amino acids, and elements in Vivamel medical chestnut honey provide mechanisms that are consistent with and follow the TIME concept.
THE IMPORTANCE OF THE RIGHT APPROACH TO WOUND CARE
promote granulation and epithelialization.absorb wound exudate,control the microbial load and reduce wound odour,reduce inflammation and infection,Wound healing can be lengthy as it requires a comprehensive medical treatment.
In wound healing, holistic treatment of each patient is necessary, all factors that affect healing should be taken into account. Locally, appropriate wound dressings should be used. Wound dressings are usually used when the bleeding has already stopped, i.e., when the inflammatory phase begins, and it is crucial that the wound be cleaned – it is necessary to remove necrotic tissue and impurities and reduce the microbial load. The dressings are used until the wound is healed.
Most modern wound dressings focus on promoting healing in only one phase, while Vivamel dressings with medical chestnut honey target both the inflammatory phase as well as the proliferation (granulation and epithelialization), achieving outstanding results in necrotic tissue and fibrin deposits removal.
WHEN CHOOSING A WOUND DRESSING, BEAR IN MIND THAT IT SHOULD:
→ remove dead tissue and impurities from the wound,
→ reduce inflammation and infection,
→ control the microbial load and reduce wound odour,
→ create a moist environment in which the wound heals faster,
→ absorb wound exudate,
→ promote granulation and epithelialization.
Vivamel wound dressings adapt to the needs of the wound using several mechanisms of action and thus promote the healing process, therefore, they can be used to achieve different healing objectives simultaneously.