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Rene Amaya, MD, FAAP Pediatric Specialists of Houston Infectious Disease/Wound Care Houston, TX Little Patients, Big Outcomes – The use of MEDIHONEY® in treating pediatric wounds

Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

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Page 1: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

Rene Amaya, MD, FAAP Pediatric Specialists of HoustonInfectious Disease/Wound Care

Houston, TX

Little Patients, Big Outcomes – The use of MEDIHONEY® in treating pediatric wounds

Page 2: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

Agenda

My clinical practiceWhy MEDIHONEY®? What can it do?A Review of Cases Impact on my practice  Tips & PointersQ&A

Page 3: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

Practice focuses solely on pediatric patients Premature neonates in NICU –teenagers

The only pediatric wound care center in Houston

Pts are seen in 6 hospitals throughout Houston

One outpatient clinic Over 800 pt encounters in 2013

Page 4: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

Infections Surgical Wounds

Trauma/Shear Injuries/Misc

Pressure Ulcers

IV Infiltrates

Page 5: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

What is MEDIHONEY®

Derived from the pollen and nectar of a specific Leptospermum species of plant in New Zealand 

Unique among all types of honey –maintains its effectiveness even in the presence of wound fluid

Produced by Derma Sciences and controlled against a rigorous systems and standards in manufacturing and sterilization (No bee venom, No bacterial organisms)

Page 6: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

Shown in randomized controlled trial where the mean healing time was significantly faster for wounds treated with MEDIHONEY® impregnated dressings when compared to conventional dressings1

Two key mechanisms of action create an optimal environment for wound healing – High Osmolarity and Low pH

Why MEDIHONEY®

1. Kamaratos AV, Tzirogiannis KN, Iraklianou SA, Panoutsopoulos GI, Kanellos IE, Melidonis AI. Manuka honey-impregnated dressings in the treatment of neuropathic diabetic foot ulcers. Int Wound J. 2012 ; 9: 1-7.

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High Osmolarity and Low pH (3.5‐4.5) of MEDIHONEY®

Slough, eschar,and elevated pH

High osmolarity draws fluid from deeper tissues to the wound surface to help liquefy and remove dead tissue

Low pH helps reduce the pH of the wound bed promoting a more acidic environment2‐4

Wound bed bathed and 

cleansed through autolytic 

debridement

2. Gethin G, Cowman S. Changes in pH of chronic wounds when honey dressing is used.  In: Wounds UK Conference Proceedings; 13–15 November 2006. Wounds UK, Aberdeen. 3. Milne SD, Connolly P. The influence of different dressings on the pH of the wound environment. J Wound Care. 2014 Feb;23(2):53‐4, 56‐7.  4. Leveen H, Falk G, Borek B, Diaz C, Lynfield Y, Wynkoop B, Mabunda GA et al. Chemical acidification of wounds. An adjuvant to healing and the                                         unfavourable action of alkalinity and ammonia. Annals of Surgery. 1973. 178(6): 745‐50. 

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MEDIHONEY® Paste MEDIHONEY® Gel

MEDIHONEY®HCS

MEDIHONEY®Calcium Alginate

MEDIHONEY® Honeycolloid

Different Configurations to assist Wound Bed Preparation

Page 9: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

Cases and Outcomes

Page 10: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

17 y/o WM with hx for hypoplastic left heart syndrome s/p multiple cardiac surgeries, protein losing enteropathy and chronic steroid use.

Presents following jet ski accident.  Trauma to the left lower leg. 

Had been followed by another adult wound care specialist and father transferred care over to my office. Unhappy with progress made with other physician.

9-18-12

Case 1: Trauma to left lower leg

Day 1

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Treatment included daily application of MEDIHONEY® Gel and Calcium alginate. Compression wrap around the leg.

Initially seen in the office 2‐3x week.

Case 1: Trauma to left lower leg

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9/21/12

Day 3

Case 1: Trauma to left lower leg

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Day 15

10/3/12

Case 1: Trauma to left lower leg

Page 14: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

Progression of healing over 15 Days

Case 1: Trauma to left lower leg

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Case 1: Trauma to left lower leg

Page 16: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

7 day old 33 week Premie with severe IV infiltrate secondary to TPN/IL

MEDIHONEY® gel and calcium alginate applied to wound daily to facilitate autolytic debridement of eschar

Case 2: IV Infiltrate

Day 1

3/30/14

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Day 3 Day 9

Case 2: IV Infiltrate

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Day 10 Day 11

Case 2: IV Infiltrate

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Day 17

Case 2: IV Infiltrate

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Day 54

Case 2: IV Infiltrate

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Progression over 2.5 weeks

Case 2: IV Infiltrate

8 weeks

Page 22: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

Case 3 – Facial Wounds of unknown etiology

Female, 15 yrs. developed severe right‐sided facial cellulitis with vesicular and ulcerative lesions 

Wound bed was 100% slough or hyper‐pigmented eschar. Tests revealed no clear etiology to explain the infection. 

Broad spectrum IV antibiotics.

Wounds cleansed with normal saline/ sharp debridement

Prior to MEDIHONEY Application

11‐8‐12

Page 23: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

Case 3 – Facial Wounds of unknown etiology

Day 1 of wound care

MEDIHONEY® HCS applied

Page 24: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

11‐12‐12

Day 4

Case 3 – Facial Wounds of unknown etiology

Autolytic debridement and healing in progress: 50% granulation/50% slough

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11‐8‐12 12‐7‐12

Progression over 1 month after presentation

Case 3 – Facial Wounds of unknown etiology

Page 26: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

Case 4 ‐ Severe 2nd Degree Burn

Healthy 10 y/o boy referred to the office for treatment and evaluation of a second degree burn of the left medial thigh.  Injury occurred when hot soup spilled onto his abdomen and left leg. 

Mother unhappy with progress made after two months of treatment by surgery.

Initiated MEDIHONEY® Gel and HCS

9/30/13

Day 1

Page 27: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

9/30/13

Day 1

10‐8‐13

Day 9

Case 4 ‐ Severe 2nd Degree Burn

Page 28: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

10‐15‐13

Day 16

11‐1‐13

Day 31

Healing progress 1 month after presentation

Case 4 ‐ Severe 2nd Degree Burn

Page 29: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

Impact to Practice

MEDIHONEY® is a safe and highly effective wound care intervention

Suitable for a variety of wounds Ease of application for hospital staff and family at home

Cost‐effective product Good healing outcomes in timely fashion

Page 30: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

Some Tips and Pointers

MEDIHONEY® Gel and Alginate combo for intimate contact and penetration

When visualization is important –MEDIHONEY HCS

MEDIHONEY® Paste to infiltrate deep wounds, crevices

In my experience, my procedure is to monitor and replace the dressing daily

Page 31: Rene Amaya, MD, FAAP Little Patients, Big Outcomes – The use of

Thank you!

Rene Amaya, MD, FAAP Pediatric Specialists of HoustonInfectious Disease/Wound Care

Houston, TX