(Jurnal Plastik Rekonstruksi, 2024.
Vol 11.
No 1, 22-.
BURN
Article Review
SUCRALFATE AND HONEY IN BURN WOUND HEALING: AN
ARTICLE REVIEW
Aditya Wardhana*), & Nadya Farhana Department of Surgery Ciptomangunkusumo Hospital.
Jakarta.
Indonesia
ABSTRACT
Introduction : Several studies stated that sucralfate and honey topically promote wound healing process.
Sucralfate has been used for stomatitis, excoriation in perianal and peristomal, ulcers, and burn wounds.
Honey as a food which is taken orally, is also used topically for several kind of wounds including burn wounds.
However, there is no study reviewing sucralfate and honey in burn wounds.
Method : Literature review was conducted from 1st until 6th of June 2022 using the terms of AuhoneyAy.
AusucralfateAy.
AuburnsAy and Auwound healingAy.
Pubmed.
Cohrane.
Science Direct.
Scopus, and Google Scholar were the online data bases we used.
We identified eight studies, three trials evaluated the effects of sucralfate in burn wounds and five trials evaluated the effects of honey in burn wounds.
Result : 3 Randomized Controlled Trials (RTC.
about the effects of sucralfate and 5 RCTs .
reported the effects of honey in burn wounds.
Both Sucralfate and Honey group had similar wound healing duration around 18 days and had early sign of wound healing by day 7.
Honey has faster complete wound healing compared to sucralfate by day 21.
Honey has remarkable antimicrobial effect within one hour.
No side effects were reported in both trials.
Both honey and sucralfate reduce the necessity for skin grafting.
Conclusion: Both sucralfate and honey have similar rapid re-epithelization in burn wounds, but honey has faster complete wound healing by day 21.
Both has similar antimicrobial effect, no side effects, and reduce the necessity for skin grafting.
Keywords: Sucralfate.
Honey.
Burns.
Wound Healing Latar Belakang: Beberapa studi menyatakan bahwa sucralfate dan madu secara topikal dapat mempercepat proses penyembuhan luka.
Sucralfate telah digunakan untuk stomatitis, ekskoriasi pada area perianal dan peristomal, ulkus, serta luka bakar.
Madu, yang biasanya dikonsumsi secara oral, juga digunakan secara topikal untuk berbagai jenis luka termasuk luka bakar.
Namun, belum ada studi yang mengulas penggunaan sucralfate dan madu dalam mengatasi luka bakar.
Metodologi: Tinjauan literatur dilakukan dari tanggal 1 hingga 6 Juni 2022 menggunakan istilah "madu", "sucralfate", "luka bakar", dan "penyembuhan luka".
Kami menggunakan basis data online seperti PubMed.
Cochrane.
ScienceDirect.
Scopus, dan Google Scholar.
Kami mengidentifikasi delapan studi, di mana tiga uji coba mengevaluasi efek sucralfate pada luka bakar dan lima uji coba mengevaluasi efek madu pada luka bakar.
Hasil: Tiga RCTs dengan total 170 peserta membahas efek sucralfate, sedangkan lima RCTs dengan total 474 peserta melaporkan efek madu pada luka bakar.
Baik kelompok sucralfate maupun madu menunjukkan durasi penyembuhan luka yang serupa sekitar 18 hari dan menunjukkan tanda-tanda penyembuhan luka awal pada hari Madu menunjukkan penyembuhan luka yang lebih cepat dibandingkan sucralfate pada hari ke-21.
Madu memiliki efek antimikroba yang signifikan dalam waktu satu jam.
Tidak ada efek samping yang dilaporkan dalam kedua uji coba tersebut.
Baik madu maupun sucralfate mengurangi kebutuhan untuk cangkok kulit.
Kesimpulan: Baik sucralfate maupun madu memiliki re-epitelisasi yang cepat dan serupa pada luka bakar, namun madu menunjukkan penyembuhan luka yang lebih cepat pada hari ke-21.
Keduanya memiliki efek antimikroba yang serupa, tidak ada efek samping yang dilaporkan, dan mengurangi kebutuhan untuk cangkok kulit.
Kata Kunci: Sucralfate.
Madu.
Luka Bakar.
Penyembuhan Luka Conflicts of Interest Statement:
The author.
listed in this manuscript declare the absence of any conflict of interest on the subject matter or materials discussed.
Received: 19-02-2024.
Revised: 01-03-2024.
Accepted: 26-06-2024 Copyright by Wardhana.
A & Farhana.
N .
iC P-ISSN 2089-6492.
E-ISSN 2089-9734 iC DOI: 10.
14228/jprjournal.
Published by Lingkar Studi Bedah Plastik Foundation.
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Sucralfate and Honey in Burn Wound HealingA
INTRODUCTION
Various types of dressings and topical therapy have been used for burn injuries.
Several studies stated that sucralfate and honey topically promote wound healing process in burn wounds.
Sucralfate is an aluminium salt of sucrose octa sulphate which is orally taken as a mucoprotective agent for gastrointestinal 1 Sucralfate is beneficial for skin protection and wound repair by accelerating cell proliferation leading to thickening of the epidermis and dermis.
1 Recent trials also anti-inflammatory, bacteriostatic, and pain relief of Sucralfate by binding to bFGF .
asic Fibroblast Growth Facto.
1 Topical sucralfate has been used for stomatitis, excoriation in perianal and peristomal, wound ulcers, even burn wounds.
1 On the other hand, honey is also known as a treatment option for burn wounds.
2 Honey is a sweet food substance produced by bees from sugar secretion of plants or insects.
3 Honey as a food which is taken orally, is also used topically for several kind of wounds.
2 Honey facilitates wound healing by its anti-inflammatory action and its ability to create a viscous barrier as anti-bacterial agent.
High osmolarity topical agent has been considered a valuable option in the treatment of infections, specifically burn wounds.
4 High osmolarity topical agent prevents the growth of bacteria and encourages wound healing, which can be achieved topically by honey.
4 Honey is proven having specific antibacterial properties where its osmolality ceased to be completely inhibitory to prevent the growth of Staphylococcus 4 Several studies stated that in burn wounds, honey promotes re-epithelialization and complete wound healing.
2 However, there is no study reviewing between sucralfate and honey in burn wound healing.
METHOD
This article will review between sucralfate and honey in burn wound healing.
Literature review was conducted from 1st until 6th of June 2022 using the terms of AuhoneyAy.
AusucralfateAy.
AuburnsAy and Auwound healingAy.
Pubmed.
Cohrane.
Science Direct.
Scopus, and Google Scholar were the online data bases we used.
This article qualitatively summarize the effect of sucralfate and honey in burn wounds healing.
Jurnal Plastik Rekonstruksi.
Vol.
No.
1, 2024
RESULTS
The articles were divided into two groups, the effects of sucralfate in burn wounds and the effects of honey in burn wounds.
We identified eight studies in total, three trials evaluated the effects of sucralfate in burn wounds and five trials evaluated the effects of honey in burn From Table 1, we conclude that most of the patient population of the trials were superficial partial thickness of burns with less than 50% TBSA, only few patients with full thickness of burns were included.
Godhi.
, et al6 is the only study that mentioned scald and thermal as their etiology of burns, while other studies did not mention their burn etiology.
Banati.
, et al5 and Koshariya et al7 included pediatric patients as their patient population, while Godhi.
, et al6 only included adult patients.
This means that there is a risk of bias in patient characteristics due to wide age range and unknown etiology of burns explained in two studies.
The intervention applied between studies were similar using sucralfate cream as dressings, but the control group were different in each Banati A.
, et al5 used antimicrobial cream in the control group, while Godhi.
et al6 and Koshariya et al7 used SSD (Silver sulfadiazin.
cream as their control treatment.
All studies changed the wounds dressings daily and regularly observed the outcome of the wounds.
All studies concluded that rate of reepithelialization and wound healing is significantly faster in Sucralfate group compared to other control treatment group.
5,6,7 Banati A.
, et al5 reported that rate of re-epithelialization was faster in 18.
8 days compared to control group.
Both superficial partial thickness of burns and full thickness of burns were having rapid reepithelialization in sucralfate group compare to other treatment group.
5 The incidence of secondary infection was also less frequently found in Sucralfate group compared to other control treatment group.
7 There were also no side effects of Sucralfate reported in the trials, such as aluminium in blood samples, local or systemic adverse reaction.
From Table 2, we can conclude that all patients of the trials were superficial partial thickness of burns with less than 50% TBSA.
There was no full thickness of burns included in Copyright by Wardhana.
A & Farhana.
, .
P-ISSN 2089-6492.
E-ISSN 2089-9734 iC DOI: 10.
14228/jprjournal.
This work is licensed under a Creative Commons License Attribution-Noncommercial No Derivative 4.
Jurnal Plastik Rekonstruksi.
Vol.
No.
1, 2024
Wardhana.
A & Farhana.
N .
these studies.
Subrahmanyam et al8 .
and Subrahmanyam et al9 .
mentioned thermal injuries as their burn etiology, but the rest of the studies did not mentioned their burn etiology.
All studies except Malik et al12 included pediatric patients as their patient population, while Malik et al12 only included adult patients.
This means that there is a risk of bias in patient characteristics due to wide age range between Malik et al12 study and the other studies.
All of the the intervention applied between studies were similar using pure, unprocessed, undiluted honey as wound dressings, except Malik et al12 using AoLangneseAo as their commercially natural honey.
The control group were also different in each studies.
All studies using SSD cream as their control treatment, except for Subrahmanyam et al10 .
using polyurethane film OpsiteR as their control The dressings change was varies between studies following a risk of bias in different duration of dressing change and follow Table 1.
The effects of sucralfate in burn wounds Author.
Patient Population Age Range Intervention Dressings Evaluation Outcome A In phase I, the rate of re-epithelization of superficial partial thickness of burns in Sucralfate group was faster .
8 day.
compared with antimicrobial group .
(P value < 0.
60 patients with A In full thickness burns, healthy granulation formed at less than 50% 3 days in Sucralfate group compared with TBSA.
Changed antimicrobial group .
9 day.
(P value = 0.
Banati.
41 patients had daily, swab et al5 superficial partial culture was A In phase II, healing site treated with Sucralfate was faster 63 years old Phase II: Double blind trial thickness burns taken twice that healing site treated with placebo (P value = 0.
with 25 patients of and 19 patients a week Histopathology result shows that Sucralfate cream Sucralfate group treated had full thickness promotes rapid epithelialization in superficial partial with sucralfate cream in thickness of burns with minimal side effects.
one site and placebo in A None of the 10 patients showed any detectable amount another site of aluminium in blood samples.
Phase I: 30 patients treated with sucralfate cream and the other 30 patients treated with antimicrobial A 60 patients with thermal and Adult Godhi.
et al6 partial thickness (>18 years .
of burns less than 50% TBSA 30 patients treated with topical sucralfate dressing and the other 30 patients treated with 1% SSD Changed daily for A 21 days A 50 patients Not A with less than 25 patients treated with 50% TBSA, sucralfate and the other 25 Adult and in the 45 patients with patients had bilaterally A Koshariya article, only superficial partial symmetrical wounds that et al7 stated that thickness of were treated with A .
(>12 years the wounds burns and 5 Sucralfate in one site and patients with full the other site treated with thickness of SSD reviewed A A total of 15 .
%) patients in sucralfate group had faster wound healing within 7 days, compared with SSD group, 17 .
67%) patients healed between 15 and 20 days (P value = 0.
The mean day of granulation was 8.
11 A 3.
92 days in sucralfate group, faster than SSD .
93 A 3.
29 days.
P value = 0.
The wound culture on day 1,7, and 14 did not differ significantly in both groups (P value > 0.
Rate of re-epithelialization was faster in Sucralfate group .
-22 day.
compared to SSD group .
-30 day.
By the end of the 3rd week, 50-75% of wound was healed in sucralfate group compared to 35-50% in SSD group.
The incidence of secondary infection was less frequently found in sucralfate group .
%) than in SSD group .
66%).
There were no local or systemic adverse reactions to the topical application of sucralfate.
Copyright by Wardhana.
A & Farhana.
, .
P-ISSN 2089-6492.
E-ISSN 2089-9734 iC DOI: 10.
14228/jprjournal.
This work is licensed under a Creative Commons License Attribution-Noncommercial No Derivative 4.
Sucralfate and Honey in Burn Wound HealingA Jurnal Plastik Rekonstruksi.
Vol.
No.
1, 2024
Table 2 .
The effects of honey in burn wounds Author.
Subrahmanyam et al8 .
Patient Population 50 patients burns less than 40% TBSA Age Range Dressings Evaluation Outcome A In honey treated patients, all the wounds healed by day 21 .
%) and in the SSD treated group in 21 patients .
%) (P value < 0.
25 patients treated with pure.
Changed every A Granulation tissue was formed in 21 patients in honey two days until group compared to 18 patients in SSD group by day 7.
3 Ae 60 undiluted honey A Honey-treated patients had less positive swab culture for years old and the other 25 Biopsies were bacteria in one patient compared to SSD treated group had patients treated collected on days 7 three positive swab cultures in day 21.
SSD impregnated A All honey treated patients healed completely and did not need skin grafting compared to four patients in SSD group that required skin grafting.
104 patients Subrahmanyam 1 Ae 65 et al9 .
years old burns with less than 40% TBSA Subrahmanyam et al10 .
Intervention A Healthy granulation tissue was observed earlier in honey 52 patients treated treated patients .
4 days vs 13.
4 day.
with pure.
A In honey treated group, 87% patients healed within 15 Changed daily and days vs 10% in the control group.
undiluted honey swabs taken on A The time taken for wound healing differed significantly and the other 52 day 7 and 21 between the groups (P value < 0.
patients treated A In honey group, 91% of wounds were rendered sterile with SSD compared to SSD group 7% of wounds rendered sterile impregnated gauze within 7 days.
46 patients treated In honey group, 92 patients with .
nprocessed the dressing A Signs of healing earlier shown in Honey group compared with partial undilute.
honey changed on day 2 to polyurethane group .
8 days vs 15.
3 day.
(P thickness of 3 Ae 65 impregnated gauze and repeated on value < 0.
burns less years old and 46 patients alternate days until A In honey group, 38 cases were sterile and 8 were infected than 40% treated with the wound healed.
at the end of day 8, compared to polyurethane group, 29
TBSA
polyurethane film In polyurethane remained sterile and infection was found in 17 cases.
OpsiteR group, the dressings were removed on day 8 Baghel et al11 78 patients Changed every A Honey group has faster average duration of healing 37 patients in honey third and seventh compared to SSD group .
16 days and 32.
68 day.
(P 10 Ae 50 group and 41 day and on the day value = 0.
thickness of years old patients in SSD of completion of A Wound of all honey group patients reported within 1 hour burns less became sterile compared to none with SSD (P value = 0.
than 50% TBSA Malik et al12 A The mean duration of healing was significantly faster in the sites treated with honey than in the sites treated with One site was SSD .
47 A 4.
06 versus 15.
62 A 4.
40 days.
P< 0.
treated with SSD The dressing was Adult cream and the other applied twice daily A The site treated with honey healed completely faster in less site of the same until the burn than 21 days vs 24 days for the site treated with SSD.
(>18
patient was treated wounds were fully A In honey group, six patients had positive culture for with commercially healed and Pseudomonas aeroginosa, whereas 27 patients had positive natural honey culture in SSD group.
AoLangneseAo A In honey group, eight patients required skin grafting, whereas 29 patients in SSD group were grafted.
150 patients with partial thickness of burns less than 50% TBSA All studies reported that wound healing is significantly faster in Honey group compared to Subrahmanyam et al8 .
reported that granulation formed by day 7 and the burn wounds completely healed in day 21 in Honey Subrahmanyam et al9 .
reported that healthy granulation tissue found earlier in honey treated patients and all wounds healed by day 21.
The time taken for wound healing differed significantly between honey and control group (P value < 0.
Subrahmanyam et al10.
Baghel et al11, and Malik et al12 also reported that honey treated patient healed significantly faster than Copyright by Wardhana.
A & Farhana.
N .
P-ISSN 2089-6492.
E-ISSN 2089-9734 iC DOI: 10.
14228/jprjournal.
This work is licensed under a Creative Commons License Attribution-Noncommercial No Derivative 4.
Jurnal Plastik Rekonstruksi.
Vol.
No.
1, 2024
Wardhana.
A & Farhana.
N .
patients in control group.
All honey treated patients healed completely and did not need skin grafting in Subrahmanyam et al8 .
study and less patients needed skin grafting in Honey group .
vs 27 patient.
in Malik et al12 study.
Honey treated patients also had less positive swab culture compared to each control group in all The side effects of honey was not mentioned in the trials, local nor systemic adverse reaction.
Regarding rate of re-epithelialization.
Banati , et al5 reported that rate of re-epithelialization was faster in Sucralfate group in 18.
8 days and Godhi.
, et al6 reported that 50% of patients in Sucralfate group healed faster within 7 days.
the other hand.
Baghel et al10 reported that Honey group has faster average duration of healing in 16 days and Subrahmanyam et al8 .
reported that granulation formed by day 7.
Both Sucralfate and Honey group had similar wound healing duration around 18 days and had early sign of wound healing by day 7.
Both Sucralfate and Honey had similar duration of wound healing around 18 days and reported to have early sign of wound healing by day 7.
Kosyariya et al7 also reported early rate of reepithelialization in Sucralfate group in 11-12 days while Malik et al12 also reported duration of healing in Honey group in 13.
47 A 4.
06 days (P value < 0.
In Sucralfate trials, both superficial partial thickness of burns and full thickness of burns were having rapid re-epithelialization.
5 Full thickness burn patients were not included in all of honey trials, so there were no evidences about the effect of Honey in full thickness burns.
Regarding complete wound healing.
Kosyariya et al7 reported that by the end of the 3rd week, 50-75% of wound was healed in sucralfate group while Subrahmanyam et al9 .
reported that all wounds healed by day 21 in Honey group.
This means that honey has faster complete wound healing compared to sucralfate group only had 50-75% wound healed by day 21.
Regarding incidence of secondary infection was also less frequently found in Sucralfate group.
7 Honey treated patients also had less positive swab culture compared to each control group in all Both sucralfate and honey have similar antimicrobial effects to the wounds.
But.
Baghel et al11 reported that wound of all honey group patients reported within 1 hour became sterile (P value = 0.
This is remarkably fast for the wound to become sterile within one hour.
Regarding its side effects, there were also no side effects of Sucralfate reported in the trials, such as aluminium in blood samples, local or systemic adverse reaction.
5,7 The side effects of honey also did not mentioned in the trials, local nor systemic adverse reaction.
All honey treated patients healed completely and did not need skin grafting in Subrahmanyam et al8 .
study and less patients needed skin grafting in Honey group .
vs 27 patient.
in DISCUSSION Patient Population There are eight high quality evidences including 3 RCTs .
reported the effects of sucralfate in burn wounds and 5 RCTs .
reported the effects of honey in burn wounds.
Most of the patient population of the trials were superficial partial thickness of burns with less than 50% TBSA, only few patients with full thickness of burns were included in Sucralfate None of Honey trials included full thickness of burns in their study.
Most mentioned burn etiology in the trials were thermal injuries and most trials included pediatric and adult patients as their patient population, except for Godhi A.
, et al6 and Malik et al12 only included adult patients.
Heterogenous of patient populations, burn etiology, patient's comorbid between studies are the bias factor that may affect the result of this study.
The form of the dressings and follow up We should take a note that form of the dressing also takes a role in burn wound healing.
The topical treatment applied between studies were similar using sucralfate cream as dressings in Sucralfate trials and pure, unprocessed, undiluted honey as dressings in Honey trials.
Only one study.
Malik et al12, using AoLangneseAo as their commercially natural honey.
The dressings changed daily in all of the Sucralfate trials, but varies between Honey trials following a risk of bias in different duration of dressing change and The effects of Sucralfate and Honey in Burn Wounds The effects of Sucralfate and Honey that we discuss in this study are about the rate of reepithelialization of the wound, complete wound healing, the antimicrobial, the side effects, and the necessity for skin grafting after the application of the topical treatment.
Copyright by Wardhana.
A & Farhana.
, .
P-ISSN 2089-6492.
E-ISSN 2089-9734 iC DOI: 10.
14228/jprjournal.
This work is licensed under a Creative Commons License Attribution-Noncommercial No Derivative 4.
Sucralfate and Honey in Burn Wound HealingA Jurnal Plastik Rekonstruksi.
Vol.
No.
1, 2024
Malik et al12 study.
In sucralfate trials, the need of skin grafting did not mention in the trials assuming that all of the patients in sucralfate group did not need skin grafting after the application of sucralfate.
Both of Honey and Sucralfate reduce the necessity for skin grafting after the application of the topical treatment.
CONCLUSION
Both sucralfate and honey have similar rapid re-epithelization in burn wound healing, but honey has faster complete wound healing by day Honey and Sucralfate have similar antimicrobial effect, no side effects, and reduce the necessity for skin grafting after the application of the topical treatment.
Correspondence regarding this article should be addressed to:
Aditya Wardhana Plastic Reconstructive and Aesthetic Surgeon.
Burn Unit.
Plastic Surgery Reconstruction and Aesthetics Division.
Department of Surgery Ciptomangunkusumo Hospital.
Jakarta.
Indonesia.
Jl.
Cempaka Putih Barat IIA no.
Jakarta 10520.
Indonesia.
Email: aditya_wrdn@yahoo.
REFERENCES