a) Wound debridement
In the process of wound healing, it is extremely important to remove dead tissue, which prevents healing as a physical barrier and it is also an ideal medium for bacterial growth. If there is a lot of dead tissue, it is first recommended to use a more radical method (for example, surgical removal), and then use dressings to ensure the removal of dead tissue and exudate from the wound. Medical chestnut honey is very effective for wound debridement.
Due to its high sugar content, honey activates an osmotic effect in the wound, which increases fluid flow in the tissue and triggers an immune response. The increased flow of the fluids softens a dead, non-vital tissue that detaches without pain. Osmosis also causes fluid to flow from the tissue, which reduces swelling and pain. Increased circulation in the tissue ensures a constant supply of oxygen and food for newly formed and defence cells, which help to cleanse the wound and defend against infection.
Only a cleansed wound bed enables undisturbed healing, whereas honey dissolved in the wound helps creating a moist environment for most optimal wound healing.
b) Antimicrobial activity
The most important properties of honey that affect antimicrobial activity are high sugar content, pH of honey, glucose oxidase enzyme and high levels of kinurenic acid.
High sugar content dehydrates the bacteria and the acidic pH of honey creates an environment in the wound where bacteria does not have suitable conditions for growth and development. The glucose oxidase enzyme that triggers a reaction in which hydrogen peroxide and gluconic acid are produced, additionally contributes to the antimicrobial activity of honey. Both contribute to additional lowering of pH and further aggravate conditions for growth and reproduction of the bacteria.
In more than 90% of chronic wounds, bacteria form a biofilm – they surround themselves with a special polysaccharide coating that protects against external influences, antibiotics, and immune responses of the host. Under this oxygen- and nutrient-permeable film, they reproduce and grow into colonies that inhibit wound healing. Due to its high content of kinurenic acid (up to 6 times higher than other types of honey), chestnut honey destabilizes the biofilm and prevents its formation.
c) Anti-inflammatory activity
Honey with high sugar content draws fluid from the wound (i.e., osmotic pressure). Due to osmosis, blood flow is increased in the wound and thus the inflow of defence cells that decompose the dead tissue. Osmosis is also the reason for an increased drainage from the wound, which reduces inflammation (reduced swelling and pain).
The wound excretion dilutes the honey and this activates the glucose oxidase enzyme, which triggers a chemical reaction in which low concentrations of hydrogen peroxide are slowly released. Hydrogen peroxide activates enzymes that also affect the reduction of the inflammation in the wound.
Flavonoids, proline, phenolic acids, and other antioxidants that are based on the neutralization of free radicals and the establishment of oxidative balance in tissues also have an anti-inflammatory effect.
Shortening of the inflammatory process in the wound leads to healing with less or no scarring.
d) Creating a moist environment
Chestnut honey has the perfect balance between glucose and fructose and is therefore just liquid enough to cover the wound bed fully, but not to crystallize. The honey protects the wound from external factors and infection, and it establishes a moist environment in it.
Excretion that is drawn from the wound (osmotic pressure) due to honey’s high sugar content further contributes to the moist environment
It has been proven that wounds heal up to two times faster in a moist environment.
e) Reducing unpleasant odours
Bacteria in the wound feed on dead tissue, eliminating substances that cause an unpleasant odour. When treating wounds with honey, bacteria feed on glucose and produce lactic acid. It has no unpleasant smell and it further reduces pH, which even worsens conditions for growth and reproduction of bacteria.
f) Accelerated wound healing with less scars
Clinical experience has shown that immediate and continuous wound care with dressings with medical chestnut honey accelerates healing with less or no scarring. One of the foundations of this effect is the moist wound healing environment. It has been proven that wounds heal up to two times faster in a moist environment. The main reason is that the dressing do not need to be changed as frequently, maintaining the optimal healing temperature is easier, migration of newly born cells is easier and faster, and therefore scarring is reduced.