Clinical Evaluation in Lower Limb Wound Healing under Honey

honey's capacity to heal wounds dates back to 1700BC, also well-documented during the 2nd Boer War (1902) and for the past 25 years at CHU in Limoges France; effective then and still effective today...

Immunohistochemical Evaluation of p63, E-Cadherin, Collagen I and III Expression in Lower Limb Wound Healing under Honey:

Abstract

Honey is recognized traditionally for its medicinal properties and also appreciated as a topical healing agent for infected and noninfected wounds. This study evaluates impact of honey-based occlusive dressing on nonhealing (nonresponding to conventional antibiotics) traumatic lower limb wounds (n = 34) through clinicopathological and immunohistochemical (e.g., expression of p63, E-cadherin, and Collagen I and III) evaluations to enrich the scientific validation. Clinical findings noted the nonadherence of honey dressing with remarkable chemical debridement and healing progression within 11–15 days of postintervention. Histopathologically, in comparison to preintervention biopsies, the postintervention tissues of wound peripheries demonstrated gradual normalization of epithelial and connective tissue features with significant changes in p63+ epithelial cell population, reappearance of membranous E-cadherin (P < .0001), and optimum deposition of collagen I and III (P< .0001). Thus, the present study for the first time reports the impact of honey on vital protein expressions in epithelial and connective tissues during repair of nonhealing lower limb wounds.

Introduction

Wound healing involves complex and multifactorial biological processes with overlapping stages [1]. However, in nonhealing wounds, successive repairing stages are affected by varied pathological happening including infection [2–4], imbalance in extracellular matrix formation and degradation [5, 6], impaired re-epithelialization [7] and nutritional supply, adverse microenvironment, and repeated physical trauma [8]. So, healing interventions need to address these pathological variables to facilitate cellular and molecular events towards re-epithelialization, connective tissue formation, and maturation of regenerating tissues [9–11]....

Honey, being a natural nutritional reservoir containing various organic/inorganic substances including major amounts of carbohydrates along with lipids, amino acids, proteins, vitamin, bioelements [30, 31] with acidic pH (~4) possesses multidimensional prohealing effects for infected/noninfected wounds [32], finds application as a topical agent with optimal moisture retention capacity, debridement ability and anti-inflammatory effect [33–35]. However, deeper understanding is required for biological validation of its impact especially on vital cellular and molecular events related to important repair processes like re-epithelialization, subepithelial connective tissue formation of wounds to guide clinicians...

Conclusion:

"The honey with its diverse chemical constituents (organic and inorganic) provide therapeutic support to nonhealing lower limb wounds with minimum trauma during redressing and debridement as well as in healing without hyper-granulation and less scarring. Further, therapeutic potential has been demonstrated at molecular levels through immunohistochemical depiction of prime molecular expressions in wound biopsies. The gradual increase in cell population and membranous expression of E-cadherin pointed out the transformation of nonhealing wound into healing one and achievement of collagen I and III ratio towards normalcy in posttherapeutic periods indicated proper deposition of collagens in the regenerated skin during healing."