Natural Honey as a Safe and Efficacious Alternative to Skin Grafting Post-Surgical Excision for Necrotizing Fasciitis at Primary Care Level: A Preliminary Study

Abstract

Necrotizing fasciitis is a soft tissue bacterial infection that spreads rapidly resulting in the destruction of muscles, skin, and underlying
tissue. Necrotizing fasciitis is defined as a fast and progressive inflammatory infection of the fascia leading to secondary
necrosis of the subcutaneous tissue moving along the facial plane. Fournier gangrene is a type of necrotizing fasciitis involving the
scrotum and perineal area. Patients suffering from acute necrotizing fasciitis require an effective regimen which includes surgical
removal of devitalized tissues, systemic antimicrobials and mitigating underlying systemic disease processes. The burden of treating
wounds following surgical debridement, on the other hand, can be challenging especially in the third world where resources are
scarce resulting in suboptimal wound coverage and function. At primary care level we had the opportunity of using natural honey
in 5 patients with non-healing wounds in either the lower limb or scrotum due to acute necrotizing fasciitis. This natural noninvasive
approach offers a cost-effective and efficacious alternative to dermatotraction, skin grafting and negative pressure wound
therapy. In these patients, the use of natural honey led to the restoration of the appearance and function of the fasciotomy wound
especially in patients with co-morbidities or those refusing skin grafting due to cost, religious factors, etc. The authors present the
clinical results followed by a discussion on the therapeutic properties of natural honey. This case series demonstrates the efficacy
of topical raw honey as a catalyst for speeding the healing process by secondary intention thereby offering a safe and efficacious
alternative for managing various wounds resulting from acute necrotizing fasciitis.