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

Dressing 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 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 for dressing?

5 x 6 cm (10 dressings per box)
8 x 10 cm (10 dressings per box)
8 x 20 cm (10 dressings per box)

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.
4% 純淨水加入膏和聚乙烯乙二醇,以保持敷料中的水分。

The metal ions are free floating in the ointment and attracted 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 dressing and what are its benefits?
MelMax 敷料的載體是什麼,其優點是什麼?

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 dressing?

8 x 10 cm: 4.8 gr.(克)
8 x 20 cm: 9.7 gr.(克)

Is blocking a proper drainage of exudates causing maceration?
MelMax 是否阻止了適當的滲出物排水,導致滲水導致浸漬?

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)

蜂蜜通過在傷口表面繪製滲出物,在敷料和傷口床之間創建一個非粘附介面,從而創造潮濕的環境。蜂蜜對液體的滲透性抽回確實能防止圍皮的浸漬。(臨床使用蜂蜜作為傷口敷料,彼得莫蘭,JWC第13卷,No 9,2004年10月)

Are there any side effects reported on the treatment?
(e.g. allergic reaction)
MelMax 治療是否有任何副作用報告?(例如過敏反應)

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 during the dressing has been applied.
None of the patients described dressing removal as painful – see question 11

沒有副作用,如過敏反應報告 - 狀態2011年9月
MelMax傷口敷料不應用於已知對巴克麥蜂蜜、醋酸或金屬+電子製劑極端敏感的患者。蜂蜜有滲透性,在大約15分鐘內引起刺痛感。敷料已應用。沒有一個患者將敷料描述為疼痛 - 參見問題 11

When to use the dressing?

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

MelMax® 用於嚴重植皮和/或受感染的傷口,例如:
* 急性傷口(外科/創傷創傷)
* 慢性傷口(腿部潰瘍、下肢潰瘍和糖尿病潰瘍)
* 燒傷
* 傷口床準備

How to use the dressing?

• 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.

• 仔細檢查傷口。
• 按照說明清潔傷口
• 將Mel-Max直接敷在傷口上 確保與傷口床的最佳接觸.
• 對於潮濕或溼的傷口,在Mel-Max上再覆蓋透氣敷料.可以吸收潮濕.
• 確實用透氣膠帶固定.

How to prepare the wound for the dressing application?

Necrosis and debris needs always to be removed.

Can you cut the dressing?

Yes, you can.
是的, 可以減裁需要的大小。

Can you overlay the surrounding skin?

Yes, you can.

What kind of secondary dressing do you need to apply on top of the Dressing?

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.

MelMax 傷口敷料最好每天更換一次(如果是濕感染的傷口),但如果二次敷料變髒或發生滲漏,則可能會更頻繁地更換。

How to remove the dressing?

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


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.

MMP 是一組特定的蛋白解酶。MMP 在改造額外+蜂窩矩陣方面發揮著重要作用。此外,它們通過清除受損組織和建立新的組織來説明。

How are the MMP's influencing the healing process?
MMP 如何影響癒合過程?

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?
不平衡的 MMP 生產對癒合過程有何影響?

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

MMP 的超產與非癒合條件直接相關-傷口不會癒合,或只是癒合緩慢。

Why use MelMax® in case of overproduction of MMP's (e.g. MMP2)?
為什麼在 MMP(例如 MMP2)生產過剩的情況下使用 MelMax®?

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.

最近的研究表明,幾種金屬離子與檸檬酸結合的應用,會導致與傷口癒合有關的不同細胞系統發揮作用。這將導致 MMP/TIMP 平衡的改善。

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 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

• 膿腫
• 纖維炎
• 放電
• 延遲癒合
• 變色
• 可捲曲、出血造粒組織
• 意外疼痛/壓痛
• 傷口底部的口袋/橋接
• 異常氣味
• 傷口分解

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).

一種消毒物質,可用於皮膚和傷口,殺死或防止潛在致病生物的繁殖。防腐劑可以稀釋消毒劑。防腐劑的優點是很少選擇耐藥微生物菌株,而且,作為局部藥物,不依賴血液進入傷口 - 這在缺血性傷口中尤其重要。然而,它們具有對濃度較高的組織毒性的可能缺點(Sco_Ward和Saffle,1995年)。

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

根據Randall Wolco®博士的說法,主要臨床指標是:
‐ 抗生素耐藥性
‐ 無法癒合,傷口打蠟和減弱

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.