BUCKWHEAT HONEY AND POVIDONE-IODINE WOUND HEALING DRESSING

Abstract

The present invention is a method of treating acute and chronic wounds and skin conditions. The product comprises a composition or formulation comprising a mixture of buckwheat honey and povidone-iodine. In one unique embodiment the composition is gelled. The composition is applied directly to a wound or a patient's skin or is impregnated on gauze or other similar material on a bandage or dressing for application to an exuding or non-exuding acute or chronic wound or skin condition.

Claims

1. A therapeutic wound-healing or skin condition treatment composition comprising a wound-healing or skin condition treatment effective amount of buckwheat honey and one or more bacterial agents

2. The therapeutic wound-healing or skin condition treatment composition of claim 1, wherein the buckwheat honey is 100% pure and strained.

3. The therapeutic wound-healing or skin condition treatment composition of claim 1 which comprises povidone-iodine as a bacterial agent.

4. The therapeutic wound-healing or skin condition treatment composition of claim 3, wherein the povidone-iodine comprises an about 9 to about 12% by volume iodine solution mixed with sterile water to dilute it to from about 1.5 to about 4.0% by volume.

5. The therapeutic wound-healing or skin condition treatment composition of claim 4, wherein the povidone-iodine solution is diluted to about 2.5%.

6. The therapeutic wound-healing or skin condition treatment composition of claim 3, wherein the povidone-iodine is in the form of a white powder.

7. The therapeutic wound-healing or skin condition treatment composition of claim 1 which can be provided in a tube or spray.

8. The therapeutic wound-healing or skin condition treatment composition of claim 1 which includes a gelling agent.

9. The therapeutic wound-healing or skin condition treatment composition of claim 8, wherein the gelling agent is sufficient to thicken the mixture and to substantially prevent the composition from running and to release a desired amount of the dressing to the wound.

10. A therapeutic wound-healing or skin condition treatment bandage or dressing comprising substrate material and a therapeutic wound-healing or skin treatment condition composition of claim 1.

11. The therapeutic wound-healing or skin condition treatment bandage or dressing of claim 10 which comprises a wound-healing or skin condition treatment effective amount of the therapeutic wound-healing or skin condition treatment composition.

12. The therapeutic wound-healing or skin condition treatment bandage or dressing of claim 10, wherein the substrate material comprises acetate, cotton (medical gauze), or alginate.

13. The therapeutic wound-healing or skin condition treatment bandage or dressing of claim 12 which comprises a 54 adhesive and non-adhesive bandage with from about 2 to 6 grams of wound healing composition.

14. The therapeutic wound-healing or skin condition treatment bandage or dressing of claim 13 which comprises about 4 grams of wound-healing or skin condition treatment composition.

15. The therapeutic wound-healing or skin condition treatment bandage or dressing of claim 10, wherein the wound-healing or skin condition treatment composition is impregnated into a reinforcing fiber substrate for application to a wound and is released therefrom.

16. A method of therapeutically treating a wound on or in a patient which comprises directly applying an effective amount of a wound-healing composition of claim 1 to the wound.

17. A method of therapeutically treating a skin condition on a patient which comprises directly applying an effective amount of a skin condition treatment composition of claim 1 to the wound.

18. A method of therapeutically treating a wound on a patient which comprises contacting the wound with a therapeutic wound-healing bandage or dressing of claim 10.

19. A method of therapeutically treating a skin condition on a patient which comprises contacting the skin condition with a therapeutic skin condition treatment bandage or dressing of claim 10.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0051] FIG. 1 is a graph representing the antibacterial effectiveness of buckwheat honey, heather honey, willow herb honey, lingonberry honey, and cloudberry honey, respectively, against Staphylococcus aureus;

[0052] FIG. 2 is a graph representing the antibacterial effectiveness of buckwheat honey, heather honey, willow herb honey, lingonberry honey, and cloudberry honey, respectively, against MRSA;

[0053] FIG. 3 is a graph representing the antibacterial effectiveness of buckwheat honey, heather honey, willow herb honey, lingonberry honey, and cloudberry honey, respectively, against Streptococcus pneumoniae; and

[0054] FIG. 4 is a graph representing the antibacterial effectiveness of buckwheat honey, heather honey, willow herb honey, lingonberry honey, and cloudberry honey, respectively, against Streptococcus pyogenes.

DETAILED DESCRIPTION OF THE INVENTION

[0055] Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood to one of ordinary skill in the art to which this invention belongs. Although any methods, devices or materials similar or equivalent to those described herein can be used in the practice or testing of the invention, the preferred methods, devices, and materials are now described.

[0056] The term wound-healing or skin condition treatment formulation or composition as used herein refers to a formulation or composition designed to treat wounds, lesions, skin conditions, or injuries caused by physical, metabolic, or chemical means. The wound-healing or skin condition treatment process comprises a series of steps where injured tissue is repaired or regenerated. This usually involves three steps: (a) an inflammation stage (0-3 days), (b) a cellular proliferation phase (3-12 days), and (c) a remodeling phase (3-6 months).

[0057] Typically a wound-healing or skin condition treatment formulation or composition has at least one active ingredient that helps to repair a wound or treat a skin condition. Examples of active ingredients include, but are not limited to, povidone-iodine, methylglyoxal, bacitracin, neomycin, and polymyxin (e.g., polymyxin B sulfate). A wound-healing or skin condition treatment formulation or composition may also contain inactive ingredients that are typically required for formulation. (See, e.g., U.S. Pat. No. 5,652,274 and U.S. Published Patent Application No. 2005/0043253, each of which is incorporated herein by reference.)

[0058] Healing time related to wounds or skin conditions, whether acute or chronic, depends on multiple factors. These factors include, but are not limited to, patient medical history, etiology, location, size, depth, length of time present, previous treatment, and drainage (purulent, synovial, serous, and serosanguinous).

[0059] As discussed above, wound-healing or skin condition treatment normally progresses through different phases. Wounds and skin conditions will heal in days to months. Healing may be delayed for any number of reasons. Some of these reasons include, but are not limited to, poor circulation, infection, elevated protease levels, pressure (weight-bearing), increased motion, patient non-compliance, and the like.

[0060] A chronic wound, non-healing wound, slow-to-heal wound, or stalled wound, as used herein, refers to a wound that fails to heal over a 4 to 12 week timeframe from inception of the wound to complete closure of the skin at the wound site. Such wounds commonly include external dermal wounds.

[0061] Skin wounds designated as chronic, non-healing, slow-to-heal, or stalled are commonly observed in clinical settings as venous leg ulcers, diabetic foot ulcers, pressure ulcers, arterial ulcers, ulcers of mixed etiology, burns, or non-healing surgical wounds. Other types of non-healing wounds or conditions are observed in less frequent conditions, such as, fistulae, dermatitis or vasculitis wounds, skin cancers, and radiation burns. This list is not exhaustive and is provided to show examples of such non-healing wounds or skin conditions. These wounds or skin conditions are differentiated from acute wounds or skin conditions that spontaneously heal without complications in a matter of days or weeks through the four normal phases of the wound-healing curve (hemostasis, inflammation, proliferation, and remodeling). Chronic wounds or skin conditions may persist for months or years and occasionally can last a lifetime and are therefore commonly referred to as non-healing wounds. There is a need for treatment of any of these types of non-healing wounds or skin conditions since spontaneous healing has failed to occur. In chronic wounds or skin conditions, at the cellular biological level, there is commonly a prolonged inflammatory phase often caused by elevated proteases or active infection.

[0062] Povidone-iodine was developed for commercial use in 1955. The Federal Drug Administration (FDA) has approved povidone use and stated that povidone is generally considered safe (GRAS). The Environmental Protection Agency (EPA) has concluded that iodine and iodophor complexes are very low toxicity by oral or dermal exposure.

[0063] Since it was developed, povidone-iodine has been used for the treatment of all types of wounds. Wounds such as vascular (arterial and venous), neuropathic, pressure, traumatic, post-operative, and infected wounds responded to treatment with povidone-iodine. In addition, treatment with povidone-iodine included wounds of varying depths ranging from pre-ulceration, superficial, and deep to ulcerations that extend to the tendons, joints, and bones.

[0064] In treatment with full strength (10% w/v) povidone-iodine, it was found to be too caustic and drying to the healing tissues. These issues with full strength (10% w/v) povidone-iodine led to accepted wisdom and numerous articles in the literature (for example, Kramer S, Effect of Povidone iodine on wound healing. J Vascular Nursing. 17(1):17-23. April 1999) to advocate against the use of full strength povidone-iodine (10% w/v) for wound healing.

[0065] During clinical treatment of all types and depths of wounds, treatment protocol was developed using a dilution of povidone-iodine. Various dilutions of povidone-iodine (from about 0.01 to about 10% w/v) were clinically tested over the past thirty years. The results showed that the current proposed accurate and effective dilution of about 2.5% w/v povidone-iodine has had the best reproducible effects on wound healing. The negative effects from full strength povidone-iodine (10%) were corrected by diluting the povidone-iodine to about 2.5% w/v solution.

[0066] There is no decrease in the antimicrobial properties of povidone-iodine at the about 2.5% dilution. In addition, there has been no bacterial resistance found or developed to povidone-iodine.

[0067] Further research and clinical case studies conducted on preventing and treating wounds, preventing chronicity of wounds, promoting antioxidation of healthy cells and tissue, and facilitating faster healing led to investigation of the combination of honey with povidone-iodine. Earlier studies used generic honey (sugar) and povidone-iodine in no specific combination or dilution. Buckwheat honey (fagopyrum esculentum) showed increased antioxidant, anti-inflammatory, and at least equal antibacterial properties as compared to other mono-floral honeys. The unique combination of buckwheat honey and povidone-iodine creates specific and unique benefits to wound healing. The buckwheat honey/povidone-iodine formulation or composition is for use in direct application or as part of a wound dressing for treatment of all types and depths of wounds and acute or chronic skin conditions or skin ulcerations regardless of vascular and neurologic status.

[0068] An embodiment of a buckwheat honey/povidone-iodine formulation or composition according to the invention comprises a medicinal honey with concentrations of hydrogen peroxide and polyphenols that are all in the upper concentration range of what are naturally found in various native honeys. In this first formulation, buckwheat honey provides a composition containing buckwheat honey with high natural concentrations of hydrogen peroxide and polyphenols to which povidone-iodine is added to a concentration between 500 mg/kg and 2,000 mg/kg. The phrase high natural concentrations of hydrogen peroxide and polyphenols is defined as concentrations that naturally exist in buckwheat honey where the concentration of hydrogen peroxide is in the range of about 2-4 mM and where the polyphenol concentration is in the range of about 275-575 gallic acid equivalents per gram of honey.

[0069] The buckwheat honey useful according to the invention is pure and strained, preferably seasonally harvested raw, monofloral buckwheat honey naturally rich in hydrogen peroxide (containing and/or capable of generating about 2-4 mM concentration of hydrogen peroxide), polyphenols (275-575 gallic acid equivalents of polyphenol compounds per gram of honey). Buckwheat honey, which is derived from the buckwheat flower, is dark brown with a red tint and typically has a pH of from about 3.0 to about 7.5. It has a shelf-life of two or more years if stored in a sealed container at from about 0 to 10 C. Useful buckwheat honey comprises medicinal grade, pure, unheated, microfiltered buckwheat honey such as is commercially available from, for example, Hackenberg Apiaries, Lewisburg, Pa., and other commercial apiaries.

[0070] Povidone-iodine is a natural antibacterial compound. It typically is a white powder with a pH of from about 1.5 to about 5.0, ideally about 4.5, when diluted in sterile water. Povidone-iodine has a shelf-life of about 12 months if stored in a light-resistant container at a temperature not to exceed about 35 C. Povidone-iodine is commercially available from, for example, Sigma-Aldrich, St. Louis, Mo.

[0071] A useful preparation comprising buckwheat honey and povidone-iodine comprises providone-iodine in a concentration of from about 1 to about 5% w/v povidone iodine, preferably about 2.5% w/v solution, of final honey product. This buckwheat honey/povidone-iodine composition has broad-spectrum antimicrobial activity effective to reduce the number of viable microorganisms at a wound site.

[0072] The buckwheat honey/povidone-iodine formulations or compositions are used in aqueous, ointment, or wound-dressing formulations to modulate biochemical mechanisms associated with wound healing, including decreasing both wound protease activities and active infection.

[0073] The buckwheat honey/povidone-iodine formulations or compositions can be applied directly to a wound or skin condition. In another aspect, the present invention provides a bandage or dressing for wound healing or treatment of a skin condition. The bandage or dressing comprises one or more of the buckwheat honey/povidone-iodine formulations or compositions described herein and a support or substrate. In any embodiment of the bandage or dressing, the support or substrate includes, but is not limited to, a fibrous gauze material, a hydrogel, a foam, a film, a hydrocolloid, an alginate, a collagen, or a combination of any two or more of the aforementioned. Useful bandages or dressings include BAND-AID or similar bandages that comprise adhesive backings with cotton or other material that adheres to the adhesive backings and absorbs the buckwheat honey/povidone-iodine formulations or compositions.

[0074] In another aspect of the invention, a wound or skin condition is treated with a buckwheat honey/povidone-iodine formulation or composition described herein.

[0075] In another embodiment of the buckwheat honey/povidone-iodine formulation or composition, the various compositions are used prophylactically to prevent surgical wounds in high-risk patients from post-operative wound dehiscence and non-healing. More than 53 million people undergo surgical procedures annually in the United States, with about half of these occurring under general anesthesia. Post-operative wound dehiscence has been investigated in several studies, and a small incidence has shown to be an issue of concern in all age groups, including the pediatric population, but with a higher incidence in the older population. The failure of these surgical wounds to heal in a normal time frame pushes them into the category of chronic wounds. Diabetes, obesity, cancer therapy, and vascular abnormalities, which are all increasing in incidence in the Western population, contribute to delayed healing and are considered risk factors. The prophylactic application of one or more of the buckwheat honey/povidone-iodine formulations herein to surgical incisions post-operatively in high-risk patients will aid in reducing the incidence of non-healing surgical wounds.

[0076] The components of the buckwheat honey/povidone-iodine formulation or composition surprisingly provide a synergistic effect that results in the suppression of the accumulation of a biochemical marker (e.g., proteases, and pro-inflammatory cytokines) associated with inflammation, and the up-regulation of other biochemical markers (e.g. growth factors and protease inhibitors) associated with wound healing. In addition, the components of the buckwheat honey/povidone-iodine formulations or compositions provide antibacterial activity that acts concomitantly with the anti-inflammatory activity to also provide suppression of active infections.

[0077] In some aspects of the invention pH adjusters may be needed and used in an amount which produces the desired function provided the amount of the pH adjuster does not affect the stability of composition. These pH adjusters are acids or bases that can be used to adjust the pH of the finished composition or formulation to a desired level. Examples of useful pH adjusters include, but are not limited to, acetic acid, ammonia, citric acid, ethanolamine, formic acid, oxalic acid, potassium hydroxide, sodium hydroxide, and triethanolamine. The pH adjusters are used in an effective, pH-adjusting amount of, for example, from about 0.01 to about 2.0% by weight, preferably from about 0.05 to about 1.0% by weight, based upon the desired effect. If buffering agents are required, the compounds can be used to maintain a desired pH in an aqueous environment. Examples of such buffers include, but are not limited to, boric acid, citric acid, lactic acid, fumaric acid, phosphoric acid, and salts thereof. The buffering agents are used in an effective, buffering amount of, for example, from about 0.01 to about 2.0% by weight, preferably from about 0.05 to about 1.0% by weight, based upon the desired effect.

[0078] In another aspect of the invention, the buckwheat honey/povidone-iodine formulation or composition may additionally comprise one or more hemostatic agents. Examples of such hemostatic agents include, for example, extracellular matrix protein, kaolin, zeolite, chitosan, anhydrous aluminum sulfate, and aluminum chloride hexahydrate. The hemostatic agents are used in an effective, hemostatic amount of, for example, from about 0.01 to about 2.0% by weight, preferably from about 0.05 to about 1.0% by weight, based upon the desired effect.

[0079] In another aspect of the invention addition, the buckwheat honey/povidone-iodine formulation or composition may additionally compromise one or more anesthetic agents. Examples of such anesthetic agents include, but are not limited to, lidocaine 1% and 2%, with and without epinephrine, and bupivacaine 0.25% and 0.5%, with and without epinephrine. The anesthetic agents are used in an effective, anesthetic amount of, for example, from about 0.01 to about 2.0% by weight, preferably from about 0.05 to about 1.0% by weight, based upon the desired effect.

[0080] In another aspect of the invention, the buckwheat honey/povidone-iodine composition may additionally comprise one or more anesthetic agents and one or more hemostatic agents.

[0081] In another aspect of the invention, a wound-healing or skin condition treatment dressing includes a gelling agent to thicken the mixture and to substantially prevent the composition from running and to release a desired amount of the dressing to the wound. Examples of useful gelling agents include, but are not limited to, natural polymers-proteins like gelatin, casein, collagen, egg whites, polysaccharides and semi synthetic polymers-cellulose subordinates such as carboxylmethyl cellulose, ethylcellulose, hydroxyethyl cellulose, hydroxypropyl cellulose, magnesium aluminum silicate, methylcellulose, sodium alginate, etc. The gelling agents are used in an effective, gelling amount of, for example, from about 0.01 to about 2.0% by weight, preferably from about 0.05 to about 1.0% by weight, based upon the desired effect.

[0082] Buckwheat honey/povidone-iodine formulations or compositions according to the present invention are useful for treating common chronic wounds, such as venous leg ulcers, diabetic foot ulcers, pressure ulcers, arterial ulcers, burns, non-healing surgical wounds, chronic rhinosinusitis and metritis. In addition, such formulations or compositions are also useful for treating abrasions, lacerations, minor cuts, scalds and burns, and other partial thickness wounds. The formulations or compositions are advantageously applied in a cream or ointment base for a period of time (e.g., several hours to several days) that are optionally impregnated into or associated with carrier dressing supports (e.g., fibrous gauze, hydrogel, foam, film, hydrocolloid, collagen, or alginate).

[0083] The buckwheat honey/povidone-iodine formulation or composition can be applied directly to a wound as a cream or spray or administered on a bandage or dressing comprising a substrate. For example, a 54 dressing containing the buckwheat honey/povidone-iodine formulation or composition could contain approximately four grams of pure strained buckwheat honey and about 1 to about 5% w/v (preferably about 2.5% w/v) of povidone-iodine.

[0084] This standard formulation is useful applied to a substrate in variously sized bandages or dressings or in an ointment or cream from a tube or spray. This formulation will preferably be sterilized by gamma radiation. This sterilization process was chosen because gamma radiation (25 kGy) did not affect the properties of the buckwheat honey.

[0085] The present disclosure further provides a method for treating wounds or skin conditions. In some embodiments, the method includes contacting a wound or skin condition with any buckwheat honey/povidone-iodine formulation or composition disclosed herein wherein the composition includes a medicinal honey fortified with the natural non-peroxide antibacterial compound, povidone-iodine; a pharmaceutically acceptable carrier; 1-5% w/v and the natural non-peroxide antibacterial compound effective to reduce the number of viable microorganisms at a wound site. The buckwheat honey/povidone-iodine formulations or compositions are applied to a wound or skin condition, for example, in a liquid (e.g., by irrigating or lavaging the wound or skin condition with the liquid) or in a gel or an ointment. Liquid compositions provide immediate availability of the ions and povidone-iodine to the healing tissue. In contrast, gels or ointments provide regulated delivery of the ions, medicinal honey, and povidone-iodine to the healing tissue over a sustained period of time. In some embodiments, the buckwheat honey/povidone-iodine formulation or composition is applied to a wound dressing substrate, which is subsequently applied to the wound. Advantageously, a wound dressing including any of the compositions is contacted with the wound until it is healed (3-8 months) with wound dressing changes every 24-96 hours, thereby providing a moist environment enriched with fortified medicinal honey to facilitate healing of the skin. Similarly, a dressing comprising any of the formulations described herein can be contacted with a skin condition over a period of time with periodic changes.

[0086] In another aspect of the invention, a buckwheat honey/povidine-iodine formulation or composition can be provided in a tube or spray.

[0087] In another aspect of the invention, a wound-healing or skin condition treatment bandage or dressing comprises a substrate comprising a reinforcing fiber substrate material and a wound-healing or skin condition treatment formulation comprised of buckwheat honey and povidone-iodine.

[0088] In another aspect of the invention, a wound-healing or skin condition treatment substrate comprises an effective amount of the wound-healing or skin condition treatment formulation.

[0089] In another aspect of the invention, in a wound-healing or skin condition treatment substrate, the substrate material comprises acetate, cotton (medical gauze), or alginate.

[0090] In another aspect of the invention, a wound-healing or skin condition treatment substrate comprises a 54 adhesive or non-adhesive bandage with from about 2 to about 8 grams of wound treatment dressing or formulation or composition.

[0091] In another aspect of the invention, a wound-healing or skin condition treatment substrate comprises about 4 grams of buckwheat honey/povidone-iodine formulation or composition.

[0092] In another aspect of the invention, in a wound-healing or skin condition treatment substrate, the buckwheat honey/povidone-iodine formulation or composition is impregnated into a reinforcing fiber substrate for application to a wound or skin condition and is released therefrom.

[0093] In another aspect of the invention, a method of treating a wound on or in a patient comprises directly applying an effective amount of a wound treatment formulation comprised of buckwheat honey and povidone-iodine.

[0094] In another aspect of the invention, a method of treating a skin condition on a patient comprises directly applying an effective amount of a skin condition treatment formulation comprised of buckwheat honey and povidone-iodine.

[0095] In another aspect of the invention, a method of treating a wound or a skin condition on a patient comprises contacting the wound or skin condition with a wound-healing or skin condition treatment dressing comprising a reinforcing fiber substrate material and a wound-healing or skin condition treatment formulation or composition comprised of buckwheat honey and povidone-iodine. The formulation could be, for example, as follows:

TABLE-US-00001 (a) Buckwheat Honey 2-8 grams, preferably 4 grams (b) Povidone-iodine 1-5% w/v (preferably 2.5%) (c) H.sub.2O (sterile) Dependent on w/v dilution

[0096] The buckwheat honey/povidone-iodine formulation is preferably applied to an entire wound or skin condition. The treatment protocol includes complete evaluation of the wound or skin condition and clinical preparation of the wound or skin condition. For example:

Dressing Preparation:

[0097] An amount of 0.10 grams of povidone-iodine powder is dissolved in 1.0 cc sterile water, and the resulting solution is mixed with 4 grams buckwheat honey pure, strained. The mixture is impregnated into a 54 acetate, non-woven medical grade substrate. Multiples of the buckwheat/povidone-iodine solution are made for multiple dressings. Each such substrate is protected with polyethylene liners applied to both sides, and each impregnated substrate is sealed individually in a foil pouch constructed of white polyester film fused to aluminum foil that constitutes the entire dressing package. The dressings are sterilized using a gamma radiation (minimum 25 kGy) and verified as sterile before use.

Clinical Procedure:

[0098] 1. Clinical examination of patient's skin and condition of wound, including location, etiology, size, depth, viability of all tissues, odor, infection, culture, neurovascular status, and nutrition.

[0099] 2. Debridement of all devitalize/necrotic, purulent tissue from the wound, using clinical judgment.

[0100] 3. Wound irrigation.

[0101] 4. Application of buckwheat honey/povidone-iodine dressing for complete coverage of wound, daily dressing, and appropriate and timely debridement/irrigation of wound (no soaking).

EXAMPLES

[0102] Objects and advantages of this invention are further illustrated by the following examples, but the particular materials and amounts thereof recited in these examples, as well as other conditions and details, should not be construed to unduly limit this invention.

Example 1

[0103] A composition comprises a buckwheat honey with high peroxide-induced and polyphenol-facilitated antimicrobial activity and an effective amount of povidone-iodine (1-5% w/v) to add non-peroxide antimicrobial activity, wherein each of the antimicrobial activities provides a different mechanism of antibacterial inhibition. This provides a broad spectrum antimicrobial activity effective to reduce the number of viable microorganisms at a wound site.

Example 2

[0104] In a composition similar to the composition described in Example 1, the honey is monofloral buckwheat honey that naturally generates 2-4 mM hydrogen peroxide and which naturally contains 275-575 gallic acid equivalents of polyphenol compounds per gram of honey, and wherein the amount of povidone iodine 1-5% w/v per gram of honey.

Example 3

[0105] A wound dressing comprises a composition of Example 1 or 2 and a support. The support is, for example, a hydrogel, a foam, a film, a hydrocolloid, an alginate, collagen, or a combination of any two or more thereof.

Example 4

[0106] Prior to treatment, a patient should be thoroughly informed of the nature of the treatment and any risks, and the patient should sign appropriate consent forms. In addition, a complete medical history and physical examination should be carried out prior to the initiation of treatment, medical or surgical. Understanding the etiology of the wound and the factors that are affecting the wound healing process (i.e., weight bearing, vascular status, neuropathy, osteomyelitis, etc.) are as important. Obviously, addressing such factors as these is extremely important in the successful treatment with all types of skin conditions and wounds. Multiple surgical procedures may be necessary to remove the devitalized, necrotic tissue and the surface exudate (biofilm) that was present. Also, irrigation of the wounds can be performed at the same time the wounds are surgically debrided during hospitalization.

[0107] A combined buckwheat honey and povidone-iodine sterile dressing or bandage can be used as an outpatient dressing. This dressing or bandage should be changed daily, and each patient should be seen in the office once a week. At each visit the patient would be examined, wounds would be measured, photographs would be taken, and wounds would be debrided, as necessary, with sharp non-excisional technique.

[0108] The sterile buckwheat honey (4 grams) and povidone iodine dressing or bandage (2.5% w/v) would be cut to the size and shape to completely cover a wound at each dressing change. The dressing or bandage would be applied directly to the surface of a wound entirely covering the wound. The dressing or bandage would be covered with at least one or more 44 fibrous (cotton) gauze and wrapped with 4 fibrous (cotton) KLING gauze dressings. Preferably the entire wound is covered at every dressing change in this manner whether in the office or at home. The patient's spouse or home health care provider should be educated on the proper technique for the dressing changes. The dressings should be kept clean and dry.

[0109] There could be indications where twice daily dressing changes are required. These indications could include increased wound drainage or increased wound desiccation.

[0110] While the present invention is described with respect to what is presently considered to be the preferred aspects, it is to be understood that the invention as claimed is not limited to the disclosed aspects.

[0111] Furthermore, it is understood that this invention is not limited to the particular methodology, materials and modifications described and as such may, of course, vary. It is also understood that the terminology used herein is for the purpose of describing particular aspects only, and is not intended to limit the scope of the present invention, which is limited only by the appended claims.

REFERENCES

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