EFFECTS

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.

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 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.

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.

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.

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.

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.