The management of diabetic foot ulcers represents a major clinical challenge for the therapist, and depends mainly on the general condition of the patient, the bed of the ulcer, and the local care plan. Proper management of diabetic foot ulcers prevents the occurrence of serious complications, Medical care has an important role in improving the rate of healing of diabetic foot ulcers, as several studies have shown that choosing the appropriate dressing technique and applying appropriate topical materials to the surface of the ulcer had an important and fundamental role in stimulating the healing process [11].
The results of the current study concluded that most of the study participants in both groups were non-working males and their ages ranged between (50–70) years, and this played a major role in maintaining the removal of pressure factors on the ulcer during follow-up, which contributed to the healing process, and this Consistent with (2000). Pham et al, who studied risk factors for ulcer development, found that advanced age, gender (male), and nature of occupation are risk factors for ulcer development [12].
In both groups, they are treated with insulin, and this is one of the factors that contributed to controlling the sugar level of most patients by carefully adjusting the dose. The majority of patients (60–75 percent) have ulcers for more than 21 days, and this is due to a lack of awareness of early detection of diabetic foot problems associated with diabetic neuropathy or lack of access to appropriate care, and failure of previous treatments.
In most patients in both groups, the ulcer was located on the plantar surface of the foot and the plantar surface of the first toe, which is consistent with (2006). Armstrong et al) who showed that one-third of patients who developed an ulcer were on the plantar surface of the first toe due to a compressive factor [13].
The average area was calculated at the first visit for the two groups, and there were no statistically significant differences in the area between them. The area decreased in both groups during follow-up, and the amount of decrease in the honey dressing group was greater due to the formation of granulation tissue and fibrous tissue, which tightens the edges of the ulcer and brings them closer until healing occurs. Here, the role of honey appears in preserving the tissues in the ulcer bed and stimulating the migration of epithelial cells from neighboring tissues. This is consistent with studies by Molan, who showed the role of honey in accelerating the healing process and the occurrence of healing [10].
The clinical findings in the depth of the ulcer were determined in terms of the tissue present at the edges, and the ulcer’s coverage of the skin layers during follow-up. James E et al (2007) emphasized that determining the age, area, and depth of the ulcer are considered the three most important factors in predicting what the ulcer will become. 14].
The results shown confirm the presence of statistically significant differences between the two groups, with regard to the formation of granulation tissue and the absence of necrotic tissue on the surface of the ulcer during the follow-up period, as the percentage of granulation tissue formation increased in the honey dressing group compared to the dry dressing group, where the role of honey becomes clear. In forming and maintaining granulation tissue, and getting rid of necrotic tissue, on the surface and edges of the ulcer, and this is consistent with the study that showed the role of honey in creating a suitable environment for the formation of granulation tissue in the wound bed 15 days after the start of treatment with honey, and getting rid of the remains of necrotic tissue by debridement [15]
The results of the current study are consistent with the results of the 2010 study. Moghazy et al., who concluded that honey dressing had a highly statistically significant effect on reducing the area of the ulcer by 93.3% [16], and is also consistent with the studies of Professor Malon (2005), who confirmed that honey enhances Formation of granulation tissue; Which contributes to the formation of new vessels in the wound area and the release of oxygen from the hemoglobin under the influence of the pH of the honey. These provide oxygen and nutrition to new and old tissues. It also stimulates the growth of fibroblasts through its content of hydrogen peroxide [10].
Honey works to preserve the soft tissues in the wound bed, as it does not stick to the surface of the ulcer. Due to the neutral moisture factor, which is absent in the case of a dry bandage that sticks to the surface of the ulcer and irritates the tissue when removed [17].
The results also showed that after the fourth week, the honey dressing had a greater, statistically significant effect on the process of complete healing and partial healing, compared to the dry dressing. At the end of the sixth week, we found that most of the sample members in the second honey dressing group achieved complete healing at a rate of 85%, and the rest 15% partial healing, compared to approximately half of the patients in the first group, 45% complete healing, and 35% partial healing, which are statistically significant differences.
These results were explained by the researcher (Asadullah), who concluded that applying honey is more effective in healing diabetic foot wounds as a bandage, as it reduces the healing time, the period of stay in the hospital, and the need for amputation, and thus improves the productivity of individuals, and reduces the disability resulting from amputation [18] ], On the other hand, honey forms a moist healing environment, and this environment is considered ideal for the wound healing process, as honey contains a small amount of water that forms a balance between the state of moisture and dryness, and these results are supported by (Gail & Elizabeth, 2010), who emphasized the role Wet dressing helps create an ideal environment for healing [19].
Fakoor (2007) also confirmed that honey has a major role in managing wound infections due to the antibacterial action of honey, as it acts according to the pH and solution pressure, which allows the ulcer to be cleaned of bacterial agents and gets rid of them [20].
Regarding the cases of non-healing of ulcers, which occurred in only 20% of patients in the first group, this can be attributed to the presence of ulcers that do not heal using dry dressing, because it does not contain any substance that contributes and stimulates the healing process, and these substances are present among the physical and nutritional properties of natural honey.
Also, the dry bandage may stick to the surface and edges of the ulcer, and when removed, it causes repeated damage to the tissues and newly formed capillaries that grow within the bandage at the surface of contact with the ulcer. This is in contrast to the honey bandage, which maintains a moist environment on the surface of the ulcer that does not allow the bandage to stick and promotes perfusion at the same time. [21].
The honey dressing maintains a sterile environment for the surface of the ulcer, which rids the ulcer of infection factors that hinder the healing process because it contains antibiotic-like substances. This is proven by the study of (Moghazy), who studied the clinical effectiveness of the honey dressing on diabetic foot ulcers, which concluded that signs of infection in the foot ulcers improved. ulcers in 90% of ulcers that had clinical signs of infection [16].
Last but not least, it is certain that there is no gold standard for treating ulcers, but it can be said that honey dressing had a positive and effective role in stimulating the healing of first- and second-degree diabetic foot ulcers compared to dry dressing.