By Ian Nielsen
I am sure many of you like me, have heard claims of honey being a good wound treatment. I decided to test this claim in my practice. Over the last few years I have been treating severe lower leg wounds with standard clear or raw honey, Manuka honey, with or without pretreatment with 3% hydrogen peroxide, and with occasional surgical removal of excess proud flesh or the judicial treatment with a cortisone cream.
I also tried to find a way to bandage these wounds that may be less expensive and that mostly still stay up! I restricted movement while the legs were bandaged. When wound contraction commenced and the wound seemed to be holding itself together I removed the bandage and allowed the wound to crust over and began to allow a gradual return to normal limb movement.
The wounds that have been treated have been on all legs and have included heel bulb splits, open joint wounds, complete cannon strips (the so called deglove wounds) and deep lacerations over the knee and forearm and the hock and lower thigh.
As most of you know the horse can self inflict wounds that look and are horrendous. They can be complicated by partial or complete cutting of tendons, ligaments and muscles. They can expose the bone and even rub a deep gouge into the surface of that bone.
Comment about the results
Firstly I must admit that these trials are not scientific studies. To be so, I should have treated every second wound with no honey and simply cleaned and changed bandages. Then I would have had a “control” group with which to compare the healing rates and the size of the scars at the end.
These cases were field trials and owners would not have appreciated that their horse had been selected as a control.
Therefore the results are based on my and my client’s experience with similar wounds treated in the many and various ways we have all used for eons. In scientific circles this is called anecdotal evidence and frowned upon.
Results of the trial
Honey is a very effective wound surface treatment. The time for full wound healing was in most cases almost halved.
There was no apparent difference between ordinary clear honey or Manuka or raw honey. Claims have been made for Manuka and raw (cloudy) honey and I have used it on some wounds with good effect but have also used it on alternate dressings with clear honey and not seen any difference. Some of my clients swear by raw honey and their experience with their own horses have made them firm believers in the benefit of raw honey over plain “off the shelf” clear honey.
3% hydrogen peroxide is claimed to improve the effect of the honey. One theory holds that the available oxygen released combines with nitrogen from the honey producing nitric oxide which improves blood flow to the wound. I have no idea whether this is true but when used as described later it did seem to improve the surface of the infilling tissue (the granulating tissue). Beware though, peroxide is damaging to delicate healing cells so should be used sparingly.
Bandaging and rest is paramount as wound movement is a killer to healing.
Honey in all its forms appears to be an effective antibacterial. The amount of pus and the odour on each bandage change is much less than any other wound treatment I have used.
The final scar is smaller and thinner than I would have predicted with all other forms of therapy, except of course skin grafting.
Vital to quick healing is to prevent the granulating tissue becoming so called “proud flesh” and overlapping the wound edges. As granulating tissue has no nerve endings the overlapping edge can be cut off without pain to the horse. This may be a good time to call the vet as s/he will be able to do this for you. You may be able to do it yourself next time. After having cut back proud flesh I will use Prednoderm or Panalogue to prevent fast regrowth. Both contain cortisone and are useful at this time and for one dressing change only.
Honey appears to protect the bone. I haven’t YET had a deep bone rub lead to localized death of the bone and a non healing wound. This has been a common occurrence in the past.
I find I rarely suture wounds of the lower leg. Usually they are hard to clean; there is too much tension on the suture line when finished; and they have usually been exposed to the air for too long before I get to see them. They are then deeply infected. Stitching them closed simply prevents drainage.
I used to cut away flaps that were hanging, tidy up the wound as best as possible and then bandage them with whatever was my favourite at the time.
My advice now is if the wound is fresh, the owner quickly clean the wound and push everything back to as close as it was normally and apply any non stick dressing and a firm bandage over everything. When I arrive to examine the wreck at least the wound is clean and moist. I then decide what may be salvaged. What bits of tattered tendon or muscle that will simply continue to cause wound edge movement that will have to be removed. I will irrigate the wound with bag(s) of sterile intravenous fluids. I will clean under skin flaps but at this time, will not remove any skin – even though it is hard to imagine that all the skin will remain alive. I will push all the skin flaps to as close to their normal position and then the bandage is applied.
Bandaging the leg
The wound dressing is made from disposable baby’s nappies. The wings and top and bottom are cut off and then the remainder is cut to a size larger than the wound. Honey is poured onto the nappy (skin side of course) and pressed firmly onto the wound. A roll of cotton wool is used as padding and usually wrapped from below the wound to above. Commonly a third to a half a roll is used. A 4 inch heavy (washable) crepe bandage holds everything in place and is secured by one or two elastoplasts. Using a pair of cheap disposable gloves Crib Stop paste is then applied to the elastoplast surface. This is essential as the horse will chew the bandage off in no time especially with the honey underneath. Make sure no Crib Stop gets onto the horse’s leg.
I change the bandage every 3 to 4 days. I do not wash the wound but “dry clean” with freshly washed clean dry towels until all the old dressing, tissue, serum, blood and pus are removed. Wetting the wound between changes simply adds to the muck next time. With dirty wounds and especially with the early dressings I will syringe onto the wound 3% hydrogen peroxide. This will fizz and run down the leg but a white surface of bubbles will adhere to the open wound. I carefully clean away all the peroxide except for that remaining on the wound surface. I then replace the honey bandage as described. Once the wound is clean and healing, I rarely use the peroxide.
To prevent the bandage slipping or being pulled down by the horse use plenty of Crib Stop paste AND with high cannon wounds, always take the bandage above the knee or hock.
The cost of material used, is a roll of cotton wool per week, a jar of honey, 4 heavy crepes (1 on the horse, 1 soaking, 1 being washed and 1 drying), a jar of Crib Stop paste, a box of disposable nappies, a small bottle of 3% hydrogen peroxide and however many elastoplasts and of course, your time. You will need a partner/friend.
Managing the horse
The horse is kept in a stable until the wound is holding together firmly. If the skin flap is dying back or not grafting to the granulating tissue then it maybe time to trim it back. This decision usually is made for you by about the 2nd or 3rd week.
In the first week, bandage changing can be difficult as the wound is still painful. Be very gentle but firm, or arrange with your vet to do these changes with the horse sedated.
After about the 3rd change s/he will usually accept a bandage change no matter how large the wound. Of course there are exceptions to every rule!
When the wound has contracted to at least a third of its original size and the edges are closing in and no proud flesh is developing over the wound edge; when you can move both sides of the wound in opposite directions at the same time and there is no fear of it splitting open, then bandaging can stop and the horse allowed out of the box. The wound will crust over. Cream like a vitamin E cream can be applied to encourage less crust and scarring.
As a postscript:
As part of this clinical trial we took on two Thoroughbred yearlings who had demolished 5 out of 8 legs in a huge hail storm. The owner rightly requested that I euthanase both. Instead, and with his permission, we took over both horses and treated their legs with the above regime. It was not easy. They were yearlings and resented treatment. Nonetheless, with the aid of heavy sedatives, we treated these two and are pleased to report that they have both since won races. Mind you they still owe us a fortune but it was a great experience and part of a great learning curve.
The horse was anaesthetised in the above photo hence the legs are on the ground. You will see that the extensor tendon has been cut through on the bottom leg and appears as a tag sticking out from the top of the wound. The right (upper leg) has been injured to the bone and the white area in the centre of the wound is quite deep gouged bone.
The second photo. You can see the right leg has healed over the bone and has contracted quite well. This was at about 5 weeks after the injury. The left hind leg is the bandage before removal after 4 days. It is still snug and preventing wound movement. The discoloration is the cribstop paste that has been applied to the outside of the elastoplast to prevent the horse from chewing at his bandage. However he did manage to pull at the bottom of the nappy which you can see emerging from the bottom of the wound. Time to final healing when the leg was no longer bandaged was 8 weeks.
The day I went to take pictures of his healed wounds he had managed to give himself a new injury to the bottom of the right hind leg wound. Yes, he is “one of those”.