Can MelMax be used in diabetic patients? Will honey influence the blood sugar?

MelMax does not influence the insulin levels in diabetic patients. For many years the Diabetic Centre in The Netherlands has been using honey in wound care achieving excellent results without experiencing any negative effects. This may be explained by the fact that the quantity of sugar absorbed in these wounds is extremely low. There will be no detectable effects on blood sugar levels. Frequent monitoring of these levels in diabetic patients has never shown this.
Should there be any reason to suspect a change in blood sugar levels, whichever the cause, we advise close monitoring. (Diabetic) Children with large surface areas afficted should always be monitored closely.

What is MelMax?

MelMax is a sterile wound dressing impregnated with a mixture of metal‐ion formulation ointment and buckwheat honey.

What is the ratio metal‐ion formulation versus Buckwheat honey

Metal‐ion formulation ‐ 25%
Buckwheat honey ‐ 75%
The results of in vivo tests showed the best performance for this 25:75 ratio.

Why Buckwheat honey?

Dark buckwheat honey is a rich source of phenolic compounds.

What are phenolics?

Antioxidants (i.e. phenolics) are agents that can retard biologically destructive chemical reactions in foods and living organisms. These compounds are thought to protect humans from diseases.
Phenolics are general known to have antibacterial activity.
Phenolics have strong anti‐oxidant properties.

In which sizes is MelMax available?

05 x 06 cm (10 dressings per box) – order code MM050610
08 x 10 cm (10 dressings per box) – order code MM081010
08 x 20 cm (10 dressings per box) – order code MM082010

What are the benefits of MelMax?

.Normalisation of the wound micro‐environment
.Regulation of bacterial contamination
.Inhibition of ROS production
.Scavenging of oxygen radicals
.Normalisation of MMP balance

How is the active metal‐ion formulation delivered to the wound bed?

The polyethylene‐based ointment is impregnated into an acetate carrier.
It melts into the wound allowing diffusion of the metal‐ion formulation into the wound bed.
4% Purified water is added to the ointment and the polyethylene glycol to hold moisture in the dressing.
The metal ions are free floating in the ointment and a^racted to what is negatively charged (ionic exchange).
The metal ions are carried in the ionic ointment travelling into the fibroblast.
Rubidium, which is a larger ion, is the door opener to the cell followed by calcium, zinc and potassium.
An optimal contact of the dressing with the wound bed is required.

What does regulation of bacterial contamination mean?

Regulation means down‐regulation of the amount of bacteria. Our clinical investigations have shown that contaminated wounds treated with MelMax could heal properly without any sign of infection.
"MelMax keeps bacteria under control!"

What is the carrier of the MelMax dressing and what are its benefits?

The carrier is Acetate
Practical benefits of the acetate carrier over co^on gauze:
.Gradual delivery of the ointment to the wound bed
.Optimal drainage of exudate to secondary dressing
.Easy to apply
.Easy to remove
.No particles lee in the wound bed
.No irritation of the wound bed
(in contrast to co^on dressings)

How many grams of the Ionogen Formulation and Buckwheat honey are in a MelMax dressing?

08 x 10 cm: 4.8 gr.
08 x 20 cm: 9.7 gr.

Is MelMax blocking a proper drainage of exudates causing maceration?

Honey creates a moist environment by drawing exudate to the wound surface, creating a non‐ adherent interface between the dressing and wound bed. The osmotic withdrawal of fluid by honey does prevent maceration of periwound skin. (Clinical usage of honey as a wound dressing, Peter Molan, JWC vol 13, no 9, October 2004)

Are there any side effects reported on the MelMax treatment?
(e.g. allergic reaction)

No side effects, like allergic reactions have been reported – status September 2011.
MelMax wound dressings should not be used on patients with known extreme sensitivity to Buckwheat honey, acetate or metal‐ion formulation.
Honey has an osmotic effect, which can cause a prickling pain sensation during approx. 15 minutes aeer the dressing has been applied.
None of the patients described dressing removal as painful – see question 11

When to use MelMax?

MelMax® is intended for use with critically colonised and/or infected wounds, like:
• Acute wounds (surgical/trauma wounds)
• Chronic wounds (leg ulcers, decubitus and diabetic ulcers)
• Burns
• Wound bed preparation

What is the position of MelMax® in the BLACK/YELLOW/RED classification model? ‐ Visit

our website click Classifica2on model
MelMax® is developed for cleaning and healing wounds through:
• Regulation of bacterial contamination
• Inhibition of ROS production
• Balancing the MMP production.

Black wounds:
Objective of treatment: Removal of necrosis
Positioning MelMax: Black (without dry necrosis) wounds

Yellow wounds:
Objective of treatment: Removal fibrin layer and pus. Cleansing of the wound
Positioning MelMax:
Yellow and green wounds.
Wounds in black/yellow area.
Wounds in yellow/red area

Not indicated for clean granulating, non‐infected wounds.

How to use MelMax®?

• Carefully inspect the wound.
• Cleanse the wound according to instructions.
• Apply MelMax directly over the wound assuring an optimal contact with the wound bed.
• For moist or wet wounds apply a secondary absorbing dressing over the MelMax
• Secure with perforated adhesive tape.

How to prepare the wound for MelMax® application?

Necrosis and debris needs always to be removed.

Can you cut the dressing?

Yes, you can.

Can you overlay the surrounding skin?

Yes, you can.

What kind of secondary dressing do you need to apply on top of MelMax®?

Principelle Matrix can be used as secondary dressing for wet to dry wounds.
Traditional dressings, foams and/or alginate can be used as a secondary dressing.

How to fixate the dressing?

You can fixate the dressing with skin friendly tape or with transparent film‐plaster.

When to change the dressing?

MelMax wound dressings should be changed preferably once per day (in case of wet infected wounds), however if the secondary dressing becomes soiled or leakage occurs it may be changed more frequently.
Most users change the dressing once every other day (in case of moist wounds) or even every third day (in case of dry wounds).
Our recommendation is to change daily at the start of the treatment. Based on the healing tendency the treatment can be extended from once per day to once every third day.

How to remove the dressing?

Remove the MelMax gently.
In case of some adhesiveness →Moisture the dressing prior to removal

When to change the dressing?

MelMax wound dressings should be changed preferably once per day (in case of wet infected wounds), however if the secondary dressing becomes soiled or leakage occurs it may be changed more frequently.
Most users change the dressing once every other day (in case of moist wounds) or even every third day (in case of dry wounds).
Our recommendation is to change daily at the start of the treatment. Based on the healing tendency the treatment can be extended from once per day to once every third day.

How to remove the dressing?

Remove the MelMax gently.
In case of some adhesiveness →Moisture the dressing prior to removal

Which features of Buckwheat honey contribute to the bacterial contamination?

• The phenolic constituents
• Low pH of 3.5 – 4.5
• High free acid content of buckwheat honey present at 50 milli‐equivalents/kg
• The low moisture content of 16.8%

Is Buckwheat honey safe for medical use?

To guarantee the product to be safe, Buckwheat honey was tested for contamination with heavy metals, pesticides, and antibiotics. The product is also gamma sterilised.

What are Matrix Metalloproteinases (MMP's)?

MMP's are a specific group of proteolytic enzymes. MMP's are playing an important role in remodelling extra‐cellular matrix. Furthermore, they help by clearing damaged tissue and build up new tissue.

How are the MMP's influencing the healing process?

MMP's are playing an important role in both epithelial degradation and regeneration. The MMP family of enzymes is capable of breaking down almost all of the components.

What is the effect of imbalanced MMP production to the healing process?

Overproduction of MMP's is directly related to a non‐healing condition ‐ wounds will not, or only heal slowly.

Why use MelMax® in case of overproduction of MMP's (e.g. MMP2)?

Recent research shows that the application of several metal ions combined with citric acid leads to be^er functioning of different cell systems related to wound healing. This will lead to an improvement of the MMP/TIMP balance.

What are oxygen radicals?

Oxygen radicals play an important role in killing bacteria. When granulocytes are being activated their oxygen uptake rises and reactive oxygen species are formed.

What are Reactive Oxygen Species (ROS)?

Overproduction of oxygen radicals leads to overproduction of hydrogen peroxide inducing toxic levels of ROS production.

What are the side effects of overproduction of oxygen radicals?

In chronic wounds there can be overproduction of oxygen radicals damaging vital tissue.
Overproduction of hydrogen peroxide leads to the formation of reactive oxygen species killing bacteria, but also causing damage to the granulocytes itself and to all other cell systems.

Why use MelMax® in case of overproduction of oxygen radicals?

Balancing production and removal is the key. Metal ions and phenolics each play their part in tissue regeneration.

What is Colonisation?

The presence of multiplying bacteria with no overt host reaction or clinical symptoms.
Microbial colonization of wounds has conflicting implications. Some studies have failed to associate specific micro‐organisms with delayed healing. Whereas Pseudomonas and Proteus have been recovered from enlarging and necrotic lesions.
Pseudomonas aeruginosa has been linked to larger wounds and Staphylococcus aureus an beta‐haemolytic streptococci associated with delayed healing.
Evidence that colonization contributes to delayed healing in chronic wounds has also been provided (Halbert et al. 1992).

What is Critical colonisation?

A conceptual term applied to the situation where host defences cannot maintain the balance of organisms in a wound.

What is Contamination?

See colonisation

What is an Infection?

The presence of multiplying bacteria in body tissues, resulting in spreading cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen‐antibody response (host reaction).
This would be apparent as any one or more of the classical signs of inflammation i.e.
• Erythema
• Heat
• Swelling
• Pain

The current accepted diagnostic criteria for wound infection are:
• Abscess
• Cellulitis
• Discharge
• Delayed healing
• Discolouration
• Friable, bleeding granulation tissue
• Unexpected pain/tenderness
• Pocketing/bridging at base of the wound
• Abnormal smell
• Wound breakdown

An infected wound may not have all of these signs. Recent work has a^empted to validate these criteria; results show pain, followed by wound enlargement to be the most significant features of the infected wound.

What does resistance mean?

Insensitivity to an antimicrobial agent, which may be innate or acquired.

What is an Antibiotic?

A chemical substance produced by a micro‐organism which has the capacity, in dilute solutions, to selectively inhibit the growth of, or to kill other micro‐organisms.

What is a Disinfectant?

A non‐selective chemical agent that disinfects by killing or removing micro‐organisms from inert surfaces, used particularly on instruments, work surfaces, etc. and not intended for use on the tissues of the body where its toxicity would impair healing.

What is an Antiseptic?

A disinfectant substance that can be used on skin and on wounds that either kills or prevents the multiplication of potentially pathogenic organisms.
Antiseptics can be diluted disinfectants.
Antiseptics have the advantage of rarely selecting for resistant microbial strains, and, being topical do not rely on the bloodstream for access to the wound – this is particularly important in ischaemic wounds. However, they have the possible disadvantage of toxicity to the tissues at higher concentrations (Sco^ Ward and Saffle 1995).

What is a Biofilm?

A microbial colony encased in a adhesive polysaccharide matrix that is usually a^ached to a surface. All wound surfaces are host to fluctuating polymicrobial communities tolerating certain antimicrobial therapy. Biofilms are 90% water, therefore drying the wound with a super absorptive dressing is expected to be effective.
According to Dr. Randall Wolco^, key clinical indicators are:
‐ The presence of slough and exudate
‐ Antibiotic resistance
‐ Failure to heal, with the wound waxing and waning

What is a Capsule?

A dense layer of protein or polysaccharide that surrounds a bacterial cell.

What is Endotoxin?

A lipopolysaccharide toxin which is either intracellular or bound to the bacterial cell.

What is Exotoxin?

A toxin released from the bacterium. Both endo‐ and exotoxins cause damage to the host.

What are Virulence factors?

Virulence is the degree of pathogenicity and invasiveness of an invading micro‐organism.
The various factors which cause this include toxins, enzymes such as coagulase and collagenase, bacterial antigens, fimbriae, capsule and flagellae.