DIABETESClinical study of dressings used for wound management in diabetic patients has shown that their local application does not affect the blood sugar level.dressings are therefore also recommended for wound management in diabetic patients. 3,5,6

PRECAUTIONS AND CONTRAINDICATIONSAllergic reaction to honey is not common − it is, however, not recommended to use dressing in patients where it exists. Patients with allergy on the bee venom should only be treated under medical supervision. 3,8

Manufacturer: TOSAMA d.o.o., Šaranovičeva 35, 1230 Domžale, Slovenija www.tosama.si

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REFERENCES1: Kralj Kunčič M, Jaklič D, Lapanje A, Gunde-Cimerman N. Antibacterial and antimycotic activities of Slovenian honeys. British Journal of Biomedical Science 2012, 69(4): 1-52: Cooper R. Honey for wound care in the 21st century. J Wound Care 2016; 25(9): 544-523: Oryan A, Alemzadeh E, Moshiri A. Biological properties and therapeutic activities of honey in wound healing: A narrative review and meta-analysis: Journal of Tissue Viability 2016; 25, 98-1184: Bertoncelj J, Dobršek U, Jamnik M, Golob T. Analytical, Nutritional and Clinical Methods Evaluation of the phenolic content, antioxidant activity and colour of Slovenian honey. Food Chemistry, 2007; 105: 822–828 5: Moghazy AM, Shams ME, Adly OA, Abbas AH, El-Badawy MA, Elsakka DM, et al. The clinical and cost effectiveness of bee honey dressing in the treatment of diabetic foot ulcers. Diabetes Res Clin Pract 2010; 89(3): 276-816: Clinical investigation: Razvoj oblog in obližev z nanosom medu. Tosama d.o.o., 20097: Molan P.C. Debridement of wounds with honey. Journal of Wound Technology 2009; 5, 12-178: EWMA document: Debridement. Journal of wound care 2013; 22(1)

5 x 5 cm: REF 1970110 x 10 cm: REF 19703

HOW TO CHOOSE A DRESSING

ALGINATEALGINATE DRESSING WITH MEDICAL HONEY

PROTECTPOLYURETHANE FOAM TRANSFER

LAYER WITH MEDICAL HONEY

5 x 5 cm: REF 1970710 x 10 cm: REF 19709

CONTACTCONTACT LAYER WITH MEDICAL HONEY

20 g: REF 19705*50 g: REF 19702

Liquid honey from of the tube may be used as a primary dressing as such, or, if moreintensive effect is desired, as an addition to other Vivamel dressings.

TUBEMEDICAL HONEY

*10 x 10 cm: REF 19735

* available in 2019

FOR WOUNDS WITH LOW EXUDATE

FOR FRAGILE WOUNDS WITH LOWTO MODERATE EXUDATE

FOR WOUNDS WITH MODERATE

TO HEAVY EXUDATE

WOUND DRESSINGWITH MEDICAL CHESTNUT HONEY

FOR WOUNDS WITH LOW OR NO EXUDATE

dressings contain sterile medical chestnut honey. Their performance in promoting wound healing is clinically proven, and they represent a cost-effective choice. 5, 6

THE EFFECTS OF MEDICAL CHESTNUT HONEY IN THE WOUND HEALING PROCESS

PROLIFERATIVEPHASE: GRANULATIONCHARACTERIZED BY COLLAGEN AND EXTRACELLULAR MATRIX SYNTESIS, ANGIOGENESIS AND GRANULATION

Continuous release of H2O2 2,3

• promotes angiogenesis and connective tissue synthesis• promotes collagen synthesis • promotes granulation Presence of flavonoids and polyphenols 3,4

• antioxidative effectAcidic pH 2,3

• balances quantity of metalloproteases (MMP)Presence of natural sugars 3

• promotes granulationHigh amount of potassium, manganese, zinc, calcium and proline 3

• promotes collagen synthesis

Acidic pH 2,3

• provides favourable wound healing environmentViscosity of the honey ³ (optimal balance between glucose, fructose and other sugars)• enables migration of epithelial cells • provides mechanical protectionPresence of flavonoids 3

• stimulates cell proliferation, regulates metalloproteinases (MMP) synthesis

INFLAMMATORYPHASE CHARACTERIZED BY THE REMOVAL OF NON-VIABLE AND DAMAGED TISSUE, FIGHT AGAINST BACTERIA High sugar content in honey (up to 80%) causes osmotic pressure 2,3

• the tissue perfusion is increased• antimicrobial activity• macrophages and lymphocytes are attracted • inflammation and oedema are decreased• wound cleansing and autolytical debridement are enhanced7

Presence of the enzyme glucose oxidase (GO) 1,2,3

• activates slow-release of low H2O2 concentration which triggers proteolytic debridement and has antimicrobial effect Presence of flavonoids and polyphenols 2,3,7

• ensures anti-inflammatory and antioxidative effectPresence of kynurenic acid 2

• destabilizes and prevents biofilm formationAcid pH 2,3

• does not support bacterial growth

CHARACTERIZED BY KERATINOCYTES MIGRATION AND PROLIFERATION, WOUND CLOSURE

Presence of natural sugars 3

• provides energy for cell reconstructionHigh amount of potassium, manganese, zinc, calcium and prolin 3 • promotes epithelisation

Cosmetic effect 3 Clinical experience has shown that timely and continuous use of medical chestnut honey dressings leads to healing without or with less scarring.

CHARACTERIZED BY TISSUE MATURATION AND REMODELLING 3

MATURATION PHASE

1

2

23 PROLIFERATIVE

PHASE: EPITHELISATION

1

2

DYNAMICTHERAPY

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SUPPORT DEBRIDEMENT AND WOUND CLEANSING

EXHIBIT ANTIMICROBIAL AND

ANTI-INFLAMMATORY PROPERTIES

PREVENT AND DESTABILIZE BIOFILM

DECREASE ODOUR

PROMOTE GRANULATION

PROMOTE EPITHELIALISATION

INDICATIONS: Acute and chronic wounds 6

dressings:

WHAT MAKES MEDICAL CHESTNUT HONEY EXCEPTIONAL FOR WOUND HEALING?• as a saturated sugar blend, it causes osmotic pressure in the

wound, consequently stimulating autolytical debridement, 2, 3

• it contains high amount of enzyme glucose oxidase, which

activates proteolytical debridement and contributes to

antimicrobial and anti-inflammatory activity, 1,2

• acts antimicrobial (on Gram-positive and Gram-negative

bacteria in the wounds, including MRSA and VRE), 1

• it contains kynurenic acid, which destabilizes and prevents

biofilm formation, 2

• it has antimycotic properties (including Candida albicans),

• it contains high amounts of potassium, manganese, zinc, calcium

and proline, thus promoting granulation and epithelisation,3

• it contains high amount of polyphenols and flavonoids, which

exhibit antioxidative properties.4