CLINICAL ISSUES Manuka honey vs. hydrogel – a prospective, open label, multicentre, randomised controlled trial to compare desloughing efficacy and healing outcomes in venous ulcers Georgina Gethin and Seamus Cowman Objective. Comparison of desloughing efficacy after four weeks and healing outcomes after 12 weeks in sloughy venous leg ulcers treated with Manuka honey (Woundcare 18+) vs. standard hydrogel therapy (IntraSite Gel). Background. Expert opinion suggests that Manuka honey is effective as a desloughing agent but clinical evidence in the form of a randomised controlled trial is not available. There is a paucity of research which uses Manuka honey in venous ulcers. Design. Prospective, multicentre, open label randomised controlled trial. Method. Randomisation was via remote telephone. One hundred and eight patients with venous leg ulcers having ‡50% wound area covered in slough, not taking antibiotics or immunosuppressant therapy were recruited from vascular centres, acute and community care hospitals and leg ulcer clinics. The efficacy of WoundCare 18+ to deslough the wounds after four weeks and its impact on healing after 12 weeks when compared with IntraSite Gel control was determined. Treatment was applied weekly for four weeks and follow-up was made at week 12. Results. At week 4, mean % reduction in slough was 67% WoundCare 18+ vs. 52Æ9% IntraSite Gel (p =0Æ054). Mean wound area covered in slough reduced to 29% and 43%, respectively (p =0Æ065). Median reduction in wound size was 34% vs. 13% (p =0Æ001). At 12 weeks, 44% vs. 33% healed (p =0Æ037). Wounds having >50% reduction in slough had greater probability of healing at week 12 (95% confidence interval 1Æ12, 9Æ7; risk ratio 3Æ3; p =0Æ029). Infection developed in 6 of the WoundCare 18+ group vs. 12 in the IntraSite Gel group. Conclusion. The WoundCare 18+ group had increased incidence of healing, effective desloughing and a lower incidence of infection than the control. Manuka honey has therapeutic value and further research is required to examine its use in other wound aetiologies. Relevance to clinical practice. This study confirms that Manuka honey may be considered by clinicians for use in sloughy venous ulcers. Additionally, effective desloughing significantly improves healing outcomes. Key words: nursing, randomised control trials, research, tissue viability, venous leg ulcer, wound care Accepted for publication: 11 June 2008 Introduction The premise that wound healing is impaired in the presence of devitalised tissue is well supported within the literature (Sieggreen & Malkebust 1997, Baharestani 1999, NICE 2001). Its removal, when consistent with treatment goals, is considered the first step in wound bed preparation of the chronic wound (Falanga 2002). Debridement methods range from surgical to natural autolytic debridement and the method is dependent on the condition of the wound bed, Authors: Georgina Gethin, PhD, RGN, Dip HE wound care, Dip Anatomy, Dip Applied Physiology, Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland; Seamus Cowman, MSc, PhD, RNT, RGN, RPN, FFNMRCSI, PG Cert (Adults), Dip N (London), Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland Correspondence: Georgina Gethin, Lecturer, Research Centre, Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland. Telephone: 00 353 1 4022202. E-mail: ggethin@rcsi.ie 466 Ó 2008 The Authors. Journal compilation Ó 2008 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 466–474 doi: 10.1111/j.1365-2702.2008.02558.x