Non-surgical and drug treatmentsBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7546.900 (Published 13 April 2006) Cite this as: BMJ 2006;332:900
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Enoch et al (1) gave an overview on the role of natural products for
wound healing. In some ways, the history of medicine is strictly bound to
the care of wounds, especially those injuries caused in battles.
Mesopotamia (2100 BC), after cleaning a wound with beer, a bandage with
wine and turpentine was applied. In Ancient Egypt, a natural product such
as honey became common in wound management: after irrigating a wound with
wine, physicians would then cover it with fat and honey. In Greece, at the
time of Homer, wounds were covered and treated with herbs, whereas
infected wounds were healed by dropping scrapings from bronze spears into
them. Four hundred years later, Hippocrates taught that wounds should be
washed with wine, bandaged, and then saturated with more wine. Galen, of
ancient Rome, cleaned wounds with vinegar, but nevertheless believed that
suppuration (“pus bonum et laudabile”) was considered necessary for
healing. This belief prevailed for many centuries. When gunpowder was
discovered, boiling oil was used with the aim “to inactivate” the
gunpowder effect inside gunshot wounds. This practice was abandoned when,
in 1542 Ambroise Parè performed one of the first cohort studies to
demonstrate that egg yolk and turpentine were better than boiling oil on
While there are limited data on natural products such as yoghurt, that
seems to help in controlling wound odor (2), tea tree oil, and potato
peelings, there is a body of evidence on the effectiveness of honey in
wound healing (3). Honey kills staphylococci within a few hours (4), has
anti-inflammatory activity (5), and its hypertonicity provides antiseptic
While science and technology march ever forward, we must not fail to
exploit the potential of natural products for they may well represent – as
in ancient times – a hope for modern medicine.
Nicola Petrosillo, Lorena Martini
National Institute for Infectious Diseases “L. Spallanzani”, Rome,
1. Enoch S, Grey JE, Harding KG. ABC of wound healing. Non-surgical and
drug treatments. BMJ 2006 15; 332: 900-3.
2. Schulte MJ. Yougurt helps to control wound odor. Concol Nurs Forum
1993; 20: 1262.
3. Molan PC. The evidence supporting the use of honey as a wound dressing.
Int J Low Extrem Wounds 2006; 5: 40-54.
4. French VM, Cooper RA, Molan PC. The antimicrobial activity of honey
agains coagulase-negative staphylococci. J Antimicrob Chemother 2005; 56:
5. Tonks AJ, Cooper RA, Jones KP, Blair S, Parton J, Tonks A. Honey
stimulates inflammatory cytokine production from monocytes. Cytokine 2003;
Competing interests: No competing interests
We read with great interest the excellent review by Enoch et al 
on the role of non-surgical treatments and drugs in cutaneous wound
healing. The review is succinct yet comprehensive. We would, however, like
to highlight the role of VAC and maggot therapy in Orthopaedic surgery,
and their role in non-healing wounds seen in Orthopaedic patients.
In our practice in Orthopaedic surgery, we find VAC to be very useful
in treating various non-healing wounds such as those secondary to trauma,
fasciotomy wounds after release of compartment syndrome, large cavitating
wounds after extensive soft tissue debridement, dehisced surgical wounds
(e.g., after hip replacement surgery) and pressure ulcers in various
anatomical locations. The mechanism of action of VAC therapy is thought to
be by its effect on inducing increased peripheral blood flow, improving
local oxygenation, and promoting angiogenesis and good quality granulation
tissue. The mechanical tension from the vacuum attracts wound edges
centripetally and may also directly stimulate cellular proliferation of
reparative granulation tissue. As in our experience, a review of the
literature also shows VAC to be a very useful treatment in Orthopaedic
patients [2, 3].
Likewise, we have also found maggots to be beneficial in the
treatment of selected non-healing wounds in Orthopaedic patients . From
our experience we find sterile maggots (which digest slough and necrotic
material from wounds without damaging the surrounding healthy tissue) to
be effective in patients with chronic wounds, whose wound beds are covered
by slough or non-viable tissue as frequently found in chronic pressure
ulcers and various forms of neuropathic ulcers. They are also useful in
infected total knee replacements where the prosthesis is exposed.
Our experience suggests that VAC and maggot therapy are very useful
and thus should be considered as a first-line treatment (rather than
alternative treatment) in hard-to-heal, cavitating, intransigent ulcers
with sloughy and unhealthy wound beds.
1. Stuart Enoch, Joseph E Grey, Keith G Harding. ABC of wound healing: Non
-surgical and drug treatments. BMJ 2006; 332:900-903.
2. Antony S. Terrazas S. A retrospective study: clinical experience using
vacuum-assisted closure in the treatment of wounds. J Natl Med Assoc 2004;
3. Herscovici D Jr, Sanders RW, Scaduto JM, Infante A, DiPasquale T.
Vacuum-assisted wound closure (VAC therapy) for the management of patients
with high-energy soft tissue injuries. J Orthop Trauma. 2003; 17(10):683-
4. Mumcuoglu KY, Clinical applications for maggots in wound care. Am J
Clin Dermatol. 2001; 2(4):219-27
Competing interests: No competing interests