1-19 © Th. Cherbuliez, M.D... Treatment of Wounds Description CMACC 2009 December 05 Th. Cherbuliez, MD

2-19 © Th. Cherbuliez, M.D... Steps in healing Wound Description The lesion can be acute or chronic A lesion of the skin or/and mucosa They can come from a burn, a cut, a compression, a fracture They can be clean or infected. They can be superficial or include deep tissue lesion

3-19 © Th. Cherbuliez, M.D... Role of honey Wound Steps in healing 1) Protect the place from further mechanical and infectious attack Rest is, in general, the most propitious state for healing; therefore: 2) Clean the area of dead and decaying cells, coagulated materials 3) Disinfect and nourish the new tissues These steps “treat” the wound and the rested wound heals itself.

4-19 © Th. Cherbuliez, M.D... Roles of bee products Wound to “treat” the wound Role of Honey Covers the wound, no further bacterial or mechanical insult Saturation of the sugar content dehydrates bacteria Generating O + “burns” bacteria and dead tissues Protects wound from losses: fluids, electrolytes.

5-19 © Th. Cherbuliez, M.D... Wound cover; Scientific qualities Roles of bee products to “treat” the wound Role of Propolis Role of bee venom Role of Pollen Disinfectant Anesthetic Increases blood circulation in and around the wound tissue Brings proteins and electrolytes to the wound.

6-19 © Th. Cherbuliez, M.D... Practical qualities Scientific qualities of wound cover by N. Marsit (Apimondia 09) Not antigenic Non inflammatory Protects wound from external bacteria Protects wound from evaporation and electrolyte losses Fosters granulation and epithelialization Accelerates wound healing.

7-19 © Th. Cherbuliez, M.D... Wound cover Practical qualities of wound cover Price Availability Adhere to the wound without sticking or destroying new cells when removed Easy conservation

8-19 © Th. Cherbuliez, M.D... Burn wounds Wound cover Honey impregnated amnion grafts could keep four years at room temperature. Human amniotic membranes sterilized by gamma rays from cobalt-60 sources To increase conservation time of the prepared amnion grafts: Creation of a skin substitute as biological dressing

9-19 © Th. Cherbuliez, M.D... Abdominal surgical wounds Wound treatment Burns by A Berretta-Silva (Apimondia 09) This is a product that maintains its liquid state in low temperatures and provides in situ gelling property. A thermo-reversible polymer that provides sustained delivery of a formulation containing standardized propolis extract It enhances patient’s comfort and acceptance, and obtains a histological well-organized skin tissue that reduces wound healing time. Protected by patent

10-19 © Th. Cherbuliez, M.D... Chronic bone wound Surgical, infected wounds Bernard Descottes ✝ (Apimondia 09) Head of Division of visceral surgery in University Hospital in Limoges, France and Number 2 in France for liver transplant In the last 24 years honey is the only product used in this division for the healing of all wounds. 87 % of the >3500 wounds treated heal without complications. Results are faster and cheaper than those of commercial preparations. Since 1984 study of Honey for the healing of major abdominal post-operative, clean or infected wounds

11-19 © Th. Cherbuliez, M.D... Antibiotics vs Apittt Chronic, deep wound By the Apitherapy Commission of Apimondia Lavage with honey-propolis-essential oils for 9 months until clean Man, distal end of femur infected for 42 years. Wound drains pus, resistant to all used antibiotics. Patient candidate for amputation Surgical curettage of the wound. Cavity left empty Further care of the wound with honey mix until closed 4 months later Patient’s knee ankylosed. He can walk without cane.

12-19 © Th. Cherbuliez, M.D... Examples of wounds Antibiotics vs Apitherapy DateAntibioticsDaysCost USDCost/months 2000 September Amikacine 10,7,10,3,3 Amixiciline 8 Amoxicicline 6,7 Cefalexine 8 Ceporane 9 Chloramphenicol 9,6 Ciprofloxacile 7,4,8,10,9,8 Cloxacicline 9 Erytromycine 6,10,7,7,7 Kanamicine 4 Metronidazol 6 Oxaciline 2 Penicilline 9 Rifampicine 7 Sulfaprine 7,5,8,5 Tetracicline 9,6, December Vancomicine 9 Antibiotics15 months 2697, Apitherapy 9 months (≈14%)

13-19 © Th. Cherbuliez, M.D... Fish bone wound Wound Examples Chronic ankle ulcer Infected wound by fish bone Bed sore

14-19 © Th. Cherbuliez, M.D... S.M. 43 (F) Infected wound by fish bone (Staphilococcus aureus). The seventh day after. After 7 days antib.

15-19 © Th. Cherbuliez, M.D... This is the situation after 7 days of antibiotic therapy Healing after 10 days of maggot therapy and 25 days of honey dressing. One year later

16-19 © Th. Cherbuliez, M.D... This is the situation one year later. Chronic Ulcer w. Honey

17-19 © Th. Cherbuliez, M.D... Honey Chronic ulcer Bed sore w. BVT After 60 days of Honey treatment.

18-19 © Th. Cherbuliez, M.D... ! Chronic ulcer. One month later. Two months later. Three month later. Treated with bee venom. 30

19-19 © Th. Cherbuliez, M.D... x Thank you