Production Of Granulation Tissue Research Articles

Morphological features of wound repair processes under low-level laser therapy in patients with diabetic foot syndrome

Purpose. To assess morphological features of tissue regeneration processes in lower extremities in patients with the diabetic foot syndrome after low-level laser therapy (LLLT).Materials and methods. The article presents a comparative retrospective analysis of the histological material of wound tissues in 125 patients with the diabetic foot syndrome (DFS). Studied material – histological sections of wound tissues stained with hematoxylin-eosin. The material was divided into two groups: main group – 65 micro-preparations of wound tissues of DFS patients who were treated traditionally plus LLLT; control group – 60 micro-preparations of wound tissues of DFS patients who had surgical wound debridement , then traditional comprehensive therapy with local wet-drying dressings.Results and discussion. The analysis of the obtained results has shown that LLLT promotes activation of cellular components and increases their number: macrophages, lymphocytes, fi broblasts. One can also see faster regenerative processes and granulation tissue formation as well as signifi cantly less area of wound surface, if to compare to the group of patients treated with traditional comprehensive wound management and local techniques.Conclusion. LLLT in the comprehensive management of patients with DFS purulent-necrotic forms can accelerate reparative processes in wound defects and signifi cantly reduce their area. It also helps to clean wounds, to reduce or eliminate infl ammatory processes within much shorter terms than under traditional care. LLLT stimulates production of granulation tissue and accelerates epithelialization as well.

The effects of a synthetic epidermis spray on secondary intention wound healing in adult horses.

To evaluate secondary intention wound healing in the horse's limbs when treated with the synthetic epidermis spray (Novacika®, Cohesive S.A.S, France) or with a standard bandaging technique. Six Standardbred mares were included in the study. Four 2.5 x 2.5 cm full-thickness skin wounds were created on each thoracic limb. Two wounds were located on the dorsoproximal aspect of the cannon bone and the other two at the dorsoproximal aspect of the fetlock. Six hours after creation, wounds were randomly treated with synthetic epidermis spray or standard bandaging. The wounds were assessed every 4 days by gross visual assessment and using a 3D imaging camera. Analysis was performed with a 3D imaging application. Out of 46 wounds, 22 showed exuberant granulation tissue and were part of the standard bandaging group. Whether the wounds were treated with synthetic epidermis spray or standard bandaging, the time for healing was the same. The synthetic epidermis spray studied in this model has allowed healing without the production of exuberant granulation tissue but did not reduce the median wound healing time compared to a standard bandaging technique. The synthetic epidermis spray is potentially an interesting alternative for the management of secondary intention wound healing of superficial and non-infected distal limb wounds in adult horses on economical and practical aspects. However, all statistical inference (p-values especially) must be interpreted with caution, given the size of the sample.

Update on Management of Alveolar Osteitis (Dry Socket): A Review of The Literature

An inflammation of the maxilla or mandible's alveolar process is known as alveolar osteoitis (AO). The disease is usually self-limiting, but it can occasionally persist for up to seven days after extraction. It is characterized by dull, radiating discomfort that can affect the neck, eyes, or temple. Despite the fact that dry socket has been known about for over a century, its etiology is still not well understood, and there are many different treatment options with variable results. This review's objective is to look into upgrades for dry socket management. The three types of treatment endeavors were regenerative techniques, conventional approach, and empirical methodology. While contemporary therapeutic approaches influence angiogenesis and granulation tissue production, earlier approaches focused on controlling pain, preventing infections, and resolving inflammation. These later arsenals employ laser and ultrasonic technology to induce and disseminate tissue regeneration while using blood-based consumables like platelet-rich plasma. Keywords: Dry socket, Alveolar osteitis, Low Level Laser Therapy

Unique combination of hyaluronic acid and amino acids in the management of patients with a range of moderate-to-severe chronic wounds: Evidence from international clinical trials.

Chronic wounds present a prolonged burden to patients, their families and healthcare systems. There is evidence that the unique combination of hyaluronic acid (HA) and amino acids (Vulnamin®) promotes re-epithelialization of wounds and stimulates activation and proliferation of fibroblasts with a significant increase in the regeneration of epithelial cells. Tissue regeneration and tissue repair are considered to be the fundamental activities of this unique combination of HA and amino acids that distinguishes it from other wound healing products. A review of trials over the last 15 years indicates distinct advantages of the unique combination of HA and amino acids, in terms of healing rate and induction of granulation tissue production compared with HA alone.

A META-ANALYSIS: THE UTILIZATION OF NEGATIVE PRESSURE WOUND THERAPY IN DIABETIC FOOT ULCERS

Highlight : Diabetes mellitus has a global prevalence of more than 500 million individuals, and it is associated with a significant consequence known as diabetic foot ulcers (DFUs). Diabetic foot is a commonly observed complication of diabetes mellitus, characterized by the development of non-healing ulcers, which can have a substantial negative impact on the overall well-being of those affected. Negative pressure wound therapy (NPWT) effectively eliminates necrotic tissue and wound secretions, stimulates the production of granulation tissue, mitigates bacterial infection, and expedites the process of wound healing. Abstract: Introduction: Diabetes mellitus has a global prevalence and significant consequence known as diabetic foot ulcers. Negative pressure wound therapy (NPWT) is a modern therapeutic strategy for managing diabetic foot ulcers. The primary objective of this study is to assess the efficacy and safety by doing a thorough literature review and performing a meta-analysis. Methods: The search platforms chosen for this study were PubMed, Embase, and Cochrane Library databases with years of publication between 2013 and 2022. The analysis was conducted using the software RevMan 5.4 and R statistical software. Results: In the present investigation, a total of 291 articles were first subjected to screening. The analysis ultimately included nine relevant literatures after the screening process. The selected literature encompassed a collective sample size of 890 patients. The random effect model used in the analysis revealed a statistically significant discrepancy in the healing rate that had negative pressure wound therapy (NPWT) intervention with the healing rate analysis shows OR 0.77 [0.65, 0.90] p=0.0, and other outcome analysis shows no statistically significant result, adverse event incident OR 0.01 CI [0.00 to 0.04), p =0.23, and amputation rate was OR 0.01 CI [0.00 to 0.02] p = 0.81. Conclusions: This research has provided evidence of the effectiveness of negative pressure wound therapy (NPWT) as a potential approach for accelerating the wound healing process. However, when utilizing this innovative approach, it is imperative to guarantee meticulous regulation and modification of the negative pressure value to mitigate any potential risk of bleeding in the wound.

Use of a portable negative pressure wound therapy device on a hard-to-heal wound with exposed bone: a case study.

This case study examines the effectiveness of using negative pressure wound therapy (NPWT) in the management of a hard-to-heal (chronic) wound with exposed ankle bone to reduce associated wound exudate and promote production of granulation tissue. A 60-year-old male patient who was able to attend wound follow-up diligently twice weekly for eight weeks, and weekly thereafter, was selected from a private hospital to take part. During each dressing change, the wound was cleansed with superoxidised cleansing solution, and minimal sharp debridement was performed. In the authors' opinion, the NPWT device used in this study is light and convenient for use in the community or home care setting. The NPWT wound dressing was connected to the NPWT machine via a connecting tube and the device then switched on using the default setting of a negative pressure of 125mmHg. Following the application of the NPWT device, the exposed ankle bone was successfully covered with healthy granulation tissue and healed within 20 weeks with minimal exudate formation in the wound. In the authors' opinion, NPWT is able to promote progress to wound healing; to minimise unnecessary dressing changes and, based on feedback from the patient, is comfortable to wear and when in use.

Mesenchymal Stem Cells (MSCs) Therapy for Pressure Ulcers: A Literature Review

Pressure ulcers or injuries, arise from ischemic damage to soft tissues induced by unrelieved pressure over a bony prominence. They are usually difficult to treat with standard medical therapy and often they recur. Promising alternative methods for treatment are now developing in the search for better treatment choices. Within the field of regenerative medicine, ongoing research on advanced therapies seeks to treat pressure ulcers with mesenchymal stem cells (MSCs). This review was synthesized and obtained from various online databases. Scientific articles were selected based on the inclusion criteria. MSCs have anti-inflammatory capabilities, they are very helpful for treating chronic wounds such as pressure ulcers because they can restart healing infected wounds by moving the wound through a chronic inflammatory state and into the subsequent stage of healing. The research indicates that MSCs produce soluble compounds that promote the proliferative and migratory behavior of the dominant cell types in the wound. MSCs promote wound closure with promoting angiogenesis, granulation tissue production, and faster epithelialization. Additionally, it was discovered that the cells create bioactive chemicals that appear to accelerate the regeneration process. These findings show that MSC therapy affects all stages of wound healing, including inflammation, epithelialization, development of granulation tissue, and tissue remodeling. Although there are many medications to treat pressure ulcers, there are surprisingly new therapies that take use of MSCs' positive benefits and crucial for wounds that are difficult to heal.

Influence of the Fractional CO2 Laser on Immunohistochemical Expression of Smooth Muscle actin in Keloid and Hypertrophic Scars

Background: Wound healing is a set of elaborate and complex mechanisms including period of oscillation of inflammation, granulation tissue production, and tissue remodeling, which culminates in the restoration of tissue structural stability and injury. That study purposed to evaluate clinical and histopathological changes of keloid and hypertrophic scars before and after CO2 laser treatment. Methods: That interventional research was carried out on individuals with keloids and hypertrophic scars attending the Out-patient Clinic of Dermatology in Hospital of Benha University. Participants were exposed to historical analysis, Local Dermatological inspection, Tissue biopsy, Treatment course by fractional CO2 laser, follow up after treatment. Results: A statistically critical decrease in size of the lesion when comparing among pretreatment and post-treatment (p < 0.05). Vancouver scale score results were considerably higher pre-treatment than post-treatment (P<0.05). Conclusion: From the previous results we can conclude that Fractional CO2 laser is a viable therapy option for keloid and hypertrophic scars since it reduces clinical signs such as colour, thickness, and pruritus in addition to improvement at the cellular level.

The Sandwich Technique for Quick and Efficient Application of Negative Pressure Wound Therapy to the Feet and Hands: A Case Report

Introduction. NPWT is a surgical dressing that combines polyurethane foam with the subsequent application of continuous or intermittent negative pressure. NPWT facilitates granulation tissue production by macrostrain, microstrain and, if desired, fluid instillation. Sealing the polyurethane foam over the wound bed is achieved using acrylic drapes; however, this can be difficult to use in some anatomic sites. Failure to achieve an effective seal can necessitate additional supplies, which has led to increased innovation in developing a more effective NPWT seal over the target wound bed. Obtaining an effective pressure seal on the feet or hands can be difficult because these anatomic sites have distinct curvature for each digit, with multiple interdigital web spaces and independent mobility. In this case report, the authors propose a technique to apply either an acrylic drape or combination acrylic and soft silicone drape utilizing the “sandwich technique” to seal NPWT foam quickly and efficiently to the feet or hands.

Estimation of Effectiveness of Local Reactive Oxygen Species for Stimulation of Regenerative Processes in Experimental Burn Wound

The aim of this work was the comparative estimation of the efficiency of different variants of local ozone therapy in experimental burn wound. We conducted the experiments on 45 white Wistar rats being randomized for three groups. Every rat got contact thermal trauma (III degree; 20 bsp) of dorsal body surface on the area 20%. Rats of the first group received a Levomecol treatment of wound, animals of the second group were locally treated by ozonized oil, and the third group rats received a combination of ozone and oxygen gas mixture intracutaneously, and the wounds were treated with Levomecol locally. The character and particularities of post-traumatic regeneration were studied by histological investigation. Local treatment with reactive oxygen species at an early period after burning is revealed to lead to more pronounced manifestation of reparative processes in burn wounds (production of granulation tissue, epidermis regeneration) than when applying Levomecolointment, and that is accompanied by more pronounced initial manifestation of scab rejection. Applying reactive oxygen species in ointment compositions at these stages of treatment with the conjuncture of infected wounds does not contribute marked initiation of reparative processes and can even force the inflammation processes.

Role of Vacuum-assisted closure therapy in the management of chronic wounds

Vacuum-assisted closure (VAC) therapy is a relatively new concept described in the literature that increases wound-healing capacity. The aim is to investigate the effect of vacuum-assisted closure therapy on wound healing and granulation tissue formation and hence shortening of the wound bed preparation time, reduction in duration of hospital admission, and reduction in the necessity for dressing change or for debridement. Sixty-eight patients with chronic wounds were randomized to initial treatment with vacuum-assisted closure or conventional dressings. Depending upon the condition of the wound, it was debrided and dressing changed. The rate of granulation tissue production was determined by measuring the reduction in wound volume over time. The primary endpoint was a granulated wound or preparation for wound coverage techniques. The mean wound size before treatment was 26.52 cm2 and 15.84 cm2 in VAC therapy and conventional dressing group respectively. Similarly, the mean wound size after treatment was 13.35 cm2 and 14.38 cm2 in VAC therapy and conventional dressing group respectively. The duration of treatment was 14.71 days and 23.38 days with % of wound size reduction 49.66% and 9.21% in VAC therapy and conventional dressing group respectively were statistically significant. The application of controlled levels of negative pressure has been shown to accelerate debridement and promote healing in chronic wounds. It also provides a sterile, more controlled resting environment to large exudating wound surfaces.

Both fumigation and heating of moxibustion promote wound healing and tissue repair in rats with full-thickness skin incision

To investigate the effect of moxibustion on wound healing, new capillaries and tissue repair in rats with full thickness skin excision. SD rats were randomly divided into control, moxa-fumigating and moxa-heating groups, with 24 rats in each group. The full-thickness skin excision injury model was replicated according to Balaji's and colleague's methods. Rats in the moxa-fumigating group received fumigation of moxa-smog at the wound surface (25 min/time) immediately after modeling through a smoke-heat separation device, and those of the moxa-heating group received conventional thermal stimulation of the ignited moxa over the wound (25 min/time) without moxa smog, once a day for 10 consecutive days. The wound color, pus, carrion, granulation, and healing status of the rats were observed. H.E. staining and Masson staining were used to observe the local tissues and collagen fibers of the wound on the 3rd and 7th days. Newly born capillaries at the wound surface were observed on the 10th day. Following modeling, the wound area of the moxa-fumigating group on the 1st and 7th day, and those of both moxa-fumigating and moxa-heating groups on the 3rd and 5th day were significantly reduced compared with the model group (P<0.001), and the wound area of the moxa-fumigating group was obviously smaller than that of the moxa-hea-ting group (P<0.01，P<0.001). On the 3rd and 7th day after modeling, the re-epithelialization rates were significantly increased (P<0.001), and the amounts of inflammatory cells were significantly reduced in both moxa-fumigating and moxa-heating groups (P<0.001). At the same time, the re-epithelialization rate of the moxa-fumigating group was higher than that of the moxa-heating group (P<0.05，P<0.001), and the inflammatory cell count of the moxa-fumigating group was lower than that of the moxa-hea-ting group (P<0.001). On the 10th day after the modeling, the number of new capillaries and capillary density in the wound basal layer were significantly increased in both moxa-fumigating and moxa-heating groups (P<0.05, P<0.001, P<0.01), and were notably higher in the moxa-fumigating group than in the moxa-heating group (P<0.01, P<0.05). Both fumigation and heating of moxibustion can promote wound healing in rats with full-thickness skin excision injury，which may be related to their effects in controlling the inflammatory response and promoting the production of collagen fibers, granulation tissue and capillaries.

Degloving injury of the distal aspect of the limb in a horse and preventing bone sequestrum formation using multiple, partial depth cortical fenestration

Exposed or denuded bone is a common complication of wounds of the distal aspect of the limb. This clinical report describes the treatment of an extensive laceration of the right hindlimb of a 12-year-old Hungarian Warmblood Horse gelding, which was managed initially by application of hydrogel dressings to enhance autolytic debridement, subsequently, by cortical fenestration of the denuded cortical bone and by stimulating the production of granulation tissue to cover the exposed bone. An early radiographic sign of sequestrum formation (discrete changes in the outer cortex) was not seen after the injury. Six weeks later, the wound was completely covered with vascularized, healthy-appearing bed of granulation tissue, which was prepared for grafting using the punch technique. A reinforced bandage was applied for the following 7 weeks; the grafts were accepted by granulation tissue. The horse was discharged 20 weeks after admission and the owners were advised to maintain stall rest with hand walking for two weeks. Four years later the owner reported that the wound had completely healed with a good cosmetic outcome and the horse was being used in a carriage.

The Combination of Platelet Rich Plasma with Skin Needling or Subcision for Postacne Scaring: a Serial Case Study

Scaring in acne remains a common problem and became therapeutic challenges for the clinician. Several modalities were introduced, and combination therapies are required to achieve satisfactory results. Skin needling and subcision reported as effective methods for treating acne scar. The skin needling technique involves puncturing the skin multiple times with a small needle to induce collagen growth, while subcision worked by tunneling the connective tissue and scattered the fibrosis scar. Platelet-rich plasma (PRP) influences wound-healing by stimulating an intense inflammatory response and growth factors, these increase in the production of extracellular matrix and granulation tissue occurs, with vascular in-growth, fibroblastic proliferation, and collagen production also accelerated. Three male patients enrolled in the study, with grades 2-3 acne scar. There are three different methods of treatment were used to see the effect of the treatment. The first patient used the combination of topical PRP and skin needling, and the second patient received a combination of PRP injection and subcision, while the third patient obtains combination between topical PRP and skin needling continued with PRP injection and subcision. Our study revealed that PRP and skin needling or subcision is a simple technique and has the potential for improvement of acne scars. Three weeks after treatment, all three patient had smoother facial skin and reduction of acne scar severity. The combination of PRP and skin needling or and subcision is a simple, safe and rapid method for acne scars treatment.

Effects of acellular equine amniotic allografts on the healing of experimentally induced full-thickness distal limb wounds in horses.

To characterize the growth factors contained in equine amniotic membrane allograft (eAM; StemWrap scaffold and StemWrap+ injection) and to evaluate the effect of eAM on equine distal limb wound healing. Prospective experimental controlled study. Eight adult horses. Transforming growth factor (TGF)-β1, vascular endothelial growth factor (VEGF), epidermal growth factor, platelet-derived growth factor-BB, and prostaglandin E2 (PGE2 ) concentrations in StemWrap+ were assessed with enzyme-linked immunosorbent assay. Two full-thickness 6.25-cm2 skin wounds were created on each metacarpus. On one forelimb, one wound was treated with eAM, and the other was left untreated (eAM control). On the contralateral limb, one wound was treated with a silicone dressing, and the other served as negative control. Three-dimensional images were obtained to determine wound circumference and surface area analyses at each bandage change until healed. Excessive granulation tissue was debrided once weekly for 4 weeks. Biopsy samples were taken to evaluate quality of wound healing via histologic and immunohistochemistry assays. StemWrap+ contained moderate concentrations of TGF-β1 (494.10 pg/mL), VEGF (212.52 pg/mL), and PGE2 (1811.61 pg/mL). Treatment of wounds with eAM did not affect time to healing or histologic quality of the healing compared with other groups but was associated with increased granulation tissue production early in the study, particularly on day 7. Application of eAM resulted in increased granulation tissue production while maintaining appropriate healing of experimental wounds. Use of eAM is likely most beneficial for substantial wounds in which expedient production of large amounts of granulation tissue is desirable.

A systematic review of Calendula officinalis extract for wound healing.

Use of complementary and alternative medicine for wound healing is influencing mainstream medical practice. This systematic review evaluates the role of Calendula officinalis flower extract as monotherapy compared to control for wound healing in vivo. Searches were conducted in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and Scopus (up to April 2018) with 14 studies meeting the inclusion criteria, comprising 7 animal experiments and 7 clinical trials. Findings from the review on acute wound healing showed faster resolution of the inflammation phase with increased production of granulation tissue in the test groups treated with extract. These findings were consistent in five animal studies and one randomized clinical trial. Chronic wound healing studies were varied. Two clinical control studies on venous ulcers demonstrated decreased ulcer surface area compared to controls. Another randomized clinical trial demonstrated no improvement for the calendula group in diabetic leg ulcer healing. Burn healing similarly showed mixed results. Two animal studies demonstrated a prophylactic effect for the administration of calendula extract prior to burn injury. A randomized clinical trial of patients suffering from partial to full thickness burns demonstrated no benefit for topical application of calendula extract compared to controls. Two randomized clinical trials assessed the potential for extract to prevent acute post radiation dermatitis, with one study showing improvements compared to trolamine, while the other found no improvement compared to aqua gel cream. Animal studies provide moderate evidence for improved recovery from the inflammation phase and increased production of granulation tissue in calendula extract treatment groups. This review identified some evidence for the beneficial effects of C. officinalis extract for wound healing, consistent with its role in traditional medicine. There is a need for larger, well-designed randomized control trials to assess the effect of calendula on wound healing including complications.

Sustained release of stromal cell derived factor-1 from an antioxidant thermoresponsive hydrogel enhances dermal wound healing in diabetes

Diabetic foot ulcers (DFUs) are a severe complication of diabetes mellitus. Altered cell migration due to microcirculatory deficiencies as well as excessive and prolonged reactive oxygen species production are implicated in the delayed healing of DFUs. The goal of this research was to assess whether sustained release of SDF-1, a chemokine that promotes endothelial progenitor cell homing and angiogenesis, from a citrate-based antioxidant thermoresponsive polymer would significantly improve impaired dermal wound healing in diabetes. Poly (polyethylene glycol citrate-co-N-isopropylacrylamide) (PPCN) was synthesized via sequential polycondensation and free radical polymerization reactions. SDF-1 was entrapped via gelation of the PPCN+SDF-1 solution above its lower critical solution temperature (LCST) and its release and bioactivity was measured. The effect of sustained release of SDF-1 from PPCN (PPCN+SDF-1) versus a bolus application of SDF-1 in phosphate buffered saline (PBS) on wound healing was evaluated in a diabetic murine splinted excisional dermal wound model using gross observation, histology, immunohistochemistry, and optical coherence tomography microangiography. Increasing PPCN concentration decreased SDF-1 release rate. The time to 50% wound closure was 11days, 16days, 14days, and 17days for wounds treated with PPCN+SDF-1, SDF-1 only, PPCN only, and PBS, respectively. Wounds treated with PPCN+SDF-1 had the shortest time for complete healing (24days) and exhibited accelerated granulation tissue production, epithelial maturation, and the highest density of perfused blood vessels. In conclusion, sustained release of SDF-1 from PPCN is a promising and easy to use therapeutic strategy to improve the treatment of chronic non-healing DFUs.

Structural Defects of Laminin β3 N-terminus Underlie Junctional Epidermolysis Bullosa with Altered Granulation Tissue Response

Mutations in the laminin-332 (α3Aβ3γ2) genes cause junctional epidermolysis bullosa (JEB), a recessively inherited disease characterized by blistering and altered wound repair. In addition, specific mutations that affect the N-terminus of the α3A chain cause a JEB-related non-blistering condition characterized by chronic production of granulation tissue, suggesting a critical role of this region in epithelial-mesenchymal communication. We report here a 9-year-old patient with JEB with a few long-standing skin ulcers with prominent granulation tissue in the absence of active blistering. He bears a homozygous missense mutation, p.Gly254Asp, within the first laminin epidermal growth factor-like (LE) repeat of the β3 short arm. We show that p.Gly254Asp causes mis-folding of the LE motif, leading to reduced secretion of laminin-332 and structural alterations of the cutaneous basement membrane zone. These findings demonstrate, in a patient in vivo, that the β3 short arm is also involved in the outcome of the granulation tissue response.

Development and preclinical evaluation of a new galactomannan-based dressing with antioxidant properties for wound healing.

We describe a novel wound dressing (HR006) with two components: a lyophilized matrix of the galactomannan from locust bean gum (LBG) and an antioxidant hydration solution (AHsol) containing curcumin and N-acetyl-L-cysteine (NAC). Physico-structural analyses of the LBG matrix revealed homogeneous interconnected pores with high absorbing capacity showing excellent properties for moist wound care (MWC). In an in vitro oxidative stress fibroblast injury model, the AHsol showed relevant protective effects reducing intracellular reactive oxygen species (ROS) production, rescuing cell viability, and regulating expression of inflammation-related genes (COX-2, TNF-α, IL-1α, IL-1β). The new dressing showed good biocompatibility profile as demonstrated by cytotoxicity, hemocompatibility, and skin irritation tests. Moreover, in an in vivo skin wound model in pigs, this dressing enhanced the production of healthy and organized granulation tissue and re-epithelization. In summary, HR006 exhibits significant antioxidant activity, good biocompatibility, and excellent repair capabilities improving tissue remodeling and the healing of wounds.

A review of research into second intention equine wound healing using manuka honey: Current recommendations and future applications

SummaryIn addition to the generic properties of honey, manuka honey has a nonperoxide antimicrobial activity largely attributed to methylglyoxal. Commercially, manuka honey is graded against a standard antiseptic, phenol, to provide a measure of antimicrobial activity referred to as the unique manuka factor (UMF). The higher the UMF, the greater the antimicrobial activity. However, more recently, there is evidence that manuka honey can also modulate the initial inflammatory response through activation of toll‐like receptor 4 on monocytes to enhance production of cytokines important in tissue repair and regeneration. Recent studies investigating the effects of manuka honey on second intention healing of lower limb wounds in horses have shown that wounds treated with UMF 20 manuka honey retracted less and healed faster than untreated wounds. Using this wound healing model, the primary effects of manuka honey appeared to be associated with the modulation of the initial inflammatory reaction rather than its antimicrobial effects. Based on the current knowledge, treatment with manuka honey should be instituted as soon as possible after injury. Where bacterial contamination is substantial, manuka honey with a UMF ≥15 should be used. While bandages will improve the contact between the honey and the wound and may be indicated in the early stages of wound healing, prolonged bandaging may lead to the production of excessive granulation tissue. If topical treatment without a bandage is to be used, more honey is not necessarily better. Using a thin film combined with regular application, contact times may be optimised. Application 2–3 times daily to open wounds may improve efficacy. Manuka honey should be applied for at least 21 days after wounding but there may be beneficial effects if it is applied until wound healing is almost complete.