Manuka honey versus hydrogel to deslough venous leg ulcers: a randomised controlled trial

AIMS: to determine if Manuka honey could deslough venous leg ulcers in comparison to a standard agent. To determine the% of wounds healed after 4 and 12 weeks in each group. To quantify the effects on healing when wounds are desloughed. To determine changes in qualitative bacterial culture wound swabs over 4 weeks when both treatments were used. METHODS: prospective, open label, multicentre, randomised controlled trial. Randomisation via remote telephone. Wounds with ≥ 50% area covered in slough were included. WoundCare 18+ (Comvita) or IntraSite Gel (Smith +Nephew) were applied once or twice weekly for 4 weeks in conjunction with compression therapy, followed by appropriate care based on clinical evaluation for next 8 weeks. Outcome measures included;% area covered in slough, wound size, healing rates, culture swab results, level of exudate, pain scores. Analysis was on intention to treat basis. Ethical approval was granted prior to commencement. RESULTS: 35 males, 73 females age 24-89 years (mean 73 yrs) recruited from 8 centres over 34 months. Baseline comparability was established. At week 12: 30% (n=24) in honey group and 21% (n=18 gel) healed. Reduction in wound size after 12 weeks reported a 1.38 risk of healing in the honey group compared to control (p = 0.037). The mean wound area covered in slough after 4 weeks was 29% (honey) v 43%(gel) (p0.065). A slough reduction of 50% or more after 4 weeks was associated with a higher probability of healing at 12 weeks (RR 3.3, p = 0.29). Epithelization was visible earlier in honey group v gel (p 0.042). Wounds of longer duration and largest size had the highest number of pathogens. MRSA was recorded at baseline in 16% (n=18) cases. Of the 10 honey treated wounds with MRSA at baseline, it was not evident after 4 weeks in 9 cases. CONCLUSION: the probability of sloughy venous ulcers healing after 12 weeks is higher when wounds are effectively desloughed and when Manuka honey is used compared to control. It is recommended that further research is conducted to investigate the clearance of MRSA from chronic wounds when honey is used.