Full-thickness burn wounds will not heal spontaneously, and inevitably need excision. Closure of the resultant wound is required in order to reduce the risks of invasive infection, which can result in systemic sepsis. In a majority of patients with full-thickness burns, early excision and immediate autografting is recommended . In addition, it has been shown that full-thickness burn wounds are more commonly associated with infection than other tissue defects . Infection of full-thickness burn wounds is frequently caused by bacterial organisms; the most common are Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii. Given these problems, development of an alternative technique or dressing to reduce burn wound infection is of importance.
Honey can be a remedy for wound care. It is the oldest remedy for treating wounds, and dates back to the sixth century AD . The ancient Egyptians used honey in a grease-honey-lint dressing to put on infected wounds. This traditional cure was displaced in the 1940 s, before bacteria were discovered to be the cause of infection and with the discovery of antibiotics. It has recently been rediscovered by the medical profession, particularly where conventional modern therapeutic agents fail and with the trend of antibiotic-resistant wounds.
The current prevalence of antibiotic-resistant microbial species has led to a re-evaluation of the therapeutic use of ancient remedies such as honey. Honey has been reported to aid in wound healing, as it has special antibacterial and antibiotic properties . More recently, honey has been reported to have an inhibitory effect on approximately 60 species of bacteria, including aerobes and anaerobes, gram-positive and gram-negative bacteria . An antifungal action has also been observed for some yeast and species of Aspergillus and Penicillium, as well as all the common dermatophytes [5, 6]. There are now many published reports describing the effectiveness of honey in rapidly clearing infections from wounds and protecting wounds from becoming infected [5, 7–10]. Thus, it provides a moist healing environment without the risk of bacterial growth occurring, and with no adverse effects to slow the healing process. An infected wound will not heal unless bacteria are eliminated, as bacteria stimulate the inflammatory response, which can hinder the process of wound healing.
A honey dressing can undoubtedly be used on many types of wounds. Hence, previous study has produced an ideal wound dressing incorporating calcium alginate fibres and active Manuka honey . It is believed that this alginate dressing offers antibacterial barrier protection and encourages wound healing. Many researchers have established the potency of Manuka honey to heal infected wounds and prevent bacterial infection [5, 11]. However, not all honey is the same.
Tualang honey is a type of honey produced locally in Malaysia. The major components of Tualang honey are furfural derivatives such as 5-(hydroxymethyl)-furfural or HMF (25.4-185.6 mg/kg), furfural (46.9-58.5 mg/kg), 2-furylmethylketone (0.2-0.9 mg/kg), 5-methyl furfural (2.2-3.6 mg/kg) and fatty acids such as palmitic acid (341.0-531.4 mg/kg), ethyl linoleate (2.0-46.7 mg/kg) and ethyl oleate (1.6-19.1 mg/kg) . A local study about the volatile components of Tualang honey has revealed 35 volatile compounds compared to other studies by Lušić and Odeh . Odeh identified 30 compounds in Palestinian honey and Lušić identified 37 compounds from lime tree honey samples using solid phase microextraction (SPME) [14, 15]. Tualang honey shares similar compounds, but it contains compounds that were not documented in literature before. They are terpenes and phynylethanal, which have significant results on microbiological activity. Terpene is a type of phytochemicals that contributes to the antimicrobial activity of honey . Phenylethanal is an enzyme, reported to have some bactericidal effects.
Nuriza had performed an in vitro experiment on antibacterial activity of 5 types of Malaysian honey: Tualang, Hutan, Gelang, Pucuk Daun and Ee Feng Gu. Significant variation in composition of the honeys was noted. Tualang, Pucuk Daun and Ee Feng Gu honey had significant antibacterial activity against S.typhi, Staphy.aureus, S.Sonnie and E.coli in vitro .
Clostridium botulinum survives in honey, and therefore wound is at risk of botulism . It is therefore recommended the honey to be sterilized by gamma irradiation at a dose of 25 kGy. Study has shown that radiation at 25 and 50 kGy do not affect the quality of honey used .
The good wound healing properties of Malaysian honey is based on the previous studies of positive effect of honey on animal study, whereby the efficacy of using honey dressing was established [20, 21]. To our knowledge, there is no published report on animal study testing specifically the efficacy of Tualang honey compared to hydrofibre silver on full thickness burn wound. This study performed a direct comparison with the most commonly used modern dressing in clinical practice. This study used Tualang honey which has not been studied using randomized method on full thickness burn wound; which represents a robust study design. Further research is needed to optimize the effective use of this agent in clinical practice. Nevertheless, its potency on wound healing and the effectiveness of its antibacterial properties can be studied in vivo before clinical use. This study was conducted to evaluate the wound healing and antibacterial properties of Tualang honey in full-thickness burn wounds in a Sprague Dawley rat model.