The Efficacy of Topical Application of Sumbawa Forest Honey for

Wound Healing: Study on Incision Wound of Balb/C Male Mice

Nuria Lafiza Wulandini, Dedianto Hidajat, Metta Octora

Faculty of Medicine of University of Mataram, Indonesia

Keywords: Sumbawaforesthoney,woundhealing,BALB/cmalemice.

Abstract: Topical application of honey has a well-known effect for wound healing. The benefits of honey include

preventing infection, moisturizing, reducing inflammation, and stimulating tissue regulation and repair. One

of the largest sources of honey in Indonesia is Sumbawa Island. In vitro studies suggest that Sumbawa forest

honey possess antioxidant activity and ability to inhibit the growth of Staphylococcus aureus in surgical

wound infections. The purpose of this study was to determine the efficacy of topical application of Sumbawa

forest honey on incision wounds of BALB/c male mice. This was a double blind randomized control trial.

The subjects of this study were BALB/c male mice that met eligibility criteria. The study group was divided

into 3 groups; treatment group with topical application of Sumbawa forest honey, control group with 10%

povidone iodine solution and group with no treatment. From the statistical analysis, p = 0.017 was obtained.

There was a significant difference between the mean of wound length of this 3 groups. In the Mann-Whitney

Post-hoc test results, there was a significant difference between the mean of wound length in the treatment

group and the control group (p = 0.022) also between the treatment group and untreated group (p = 0.009).

The topical application of Sumbawa forest honey can accelerate the healing of incision wound on BALB / c

male mice. 

1 INTRODUCTION

Honey is a natural product produced by honey bees

(Yaghoobi & Kazerouni, 2013). Honey has many

health benefits, especially in wound care. Studies by

Medhi (2008) and Ghaderi (2004) suggested that

honey has significant efficacy in wound management.

Topical application of honey can enhance wound

healing by preventing infection, reducing

inflammation, and stimulating tissue regulation and

repair. In addition, it also does not require a sterile

environment because honey has a bactericidal

property. Honey also has a high viscosity, thus acting

as a protective barrier and forming a moist

environment that helps and accelerates wound

healing (Ghaderi & Afshar, 2004, Medhi et al., 2008).

Honey is produced in various parts of Indonesia.

One of the biggest sources of honey is the island of

Sumbawa. Honey produced in Sumbawa island

classified as forest honey. Sumbawa forest honey is a

type of pure honey derived from Apis dorsata bees

that cannot be cultivated. The potencials of Sumbawa

forest honey is associated with the condition and

typology of forests in Sumbawa. The highest

potential honey in Sumbawa produced in forest with

relatively good condition, typically damp tropical

forests characterized by Boan trees (the name for tall

trees that have beehives). This species of Boan tree

covers 45% of the protected forest area in Sumbawa.

Sumbawa forest honey were taken during the day and

were still processed traditionally by the local

community (Maryani et al., 2013; Julmansyat et al.,

2009).

Sumarlin's study (2014) showed the presence of

antioxidant activity in Sumbawa forest honey

(Sumarlin et al., 2014). In addition, in vitro research

by Zulhawa (2010) suggested that Sumbawa forest

honey can inhibit the growth of Staphylococcus

aureus in surgical wound infections. Therefore, this

study aims to determine the efficacy of topical

application of Sumbawa forest honey on healing of

incision wound in BALB/c male mice.

2 METHODS AND RESULTS

This research used double blind randomized control

trial. The subjects of this study were BALB/c male

Wulandini, N., Hidajat, D. and Octora, M.

The Efﬁcacy of Topical Application of Sumbawa Forest Honey for Wound Healing: Study on Incision Wound of Balb/C Male Mice.

DOI: 10.5220/0008150900640067

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 64-67

ISBN: 978-989-758-494-7

mice with inclusion criteria aged 2-3 months, weight

20-40 grams and had no physical disability.

Exclusion criteria were mice with hyperglycemia and

hemostasic disorders. This research was conducted in

the Integrated Animal Laboratory, Faculty of

Medicine, University of Mataram in September 2017.

This research was approved by the Ethics Committee

Faculty of Medicine, University of Mataram. This

research was divided into 3 stages: (1) adaptation and

intervention stages, (2) measurement of the remaining

length of the wounds and (3) data analysis.

Before making an incision wound, 31 mice

underwent adaptation stage. In this stage, they were

fed with the same feed for one week. Afterwards,

during the intervention stage, the back area of the

mice was first shaved and body weight and blood

glucose levels of mice were measured. The mice were

then divided randomly into 3 groups: 12 mice in the

treatment group with topical application of Sumbawa

forest honey (KP), 12 mice in the control group with

10% Povidone iodine solution (KK) and 7 mice in the

untreated group (KN). A two centimeters incision

was made on each mice using a sterile scalpel, and

after the bleeding was controlled, the treatment in

each group was continued. The intervention in the

three study groups was conducted once daily until the

21st day at the same hour. The time of incision and

the first intervention was expressed as day 0.

The second stage is the measurement of wound

length. This was done macroscopically on day- 0,1

,14

and day-21

, using a centimeter scale

ruler and taken at the same hour.

The data analysis was performed by using non-

parametric statistical test Kruskall-Wallis. Further, a

Post-hoc Mann-Whitney test was conducted to see the

significant difference between each of the two study

groups

3 RESULT

The result of the measurement of the mean of length

of remaining wound incision on day- 0,1

,14

and day-21

on 31 male BALB/c male mice can be

seen in Figure 1 and Table 1.



Figure 1. Graphic of mean wound length on day- 0,1

,14

and day-21

Table 1. The mean percentage of wound length.

Group

Number

of mice

The mean of percentage of wound length

(%)

Day

KP 12 100 90,4 74,5 62,5 44,6 4,6

KK 12 100 95,4 81,65 67,9 52,9 22,1

KN 7 100 90 81,45 69,5 54,3 30

KP: Treatment group (Sumbawa forest honey). KK: Control group (povidon iodine 10%). KN: Untreated group.

The Efﬁcacy of Topical Application of Sumbawa Forest Honey for Wound Healing: Study on Incision Wound of Balb/C Male Mice

Based on Table 1 and Figure 1, on day 21

, the

mean percentage of wound length in the treatment

group was smaller than the control group (4.6% vs.

22.1%) and untreated group (4.6% vs. 30%).

Statistical analysis was performed using Kruskall-

Wallis non-parametric test because the data was not

distributed normally. From the Kruskall-Wallis test,

p = 0.017 (p <0.05) was obtained, demonstrating a

significant difference in the mean of wound length

between the treatment group, the control group, and

untreated group. In the Mann-Whitney Post-hoc test

results, there was a significant difference between the

mean wound length of the treatment group and the

control group (p=0.022; p<0.05) also the same result

between the mean wound length of the treatment

group and untreated group (p=0.009; p<0.05).

4 DISCUSSION

The efficacy of honey on acceleration of wound

healing and antimicrobial properties of honey has

been studied so far (Yaghoobi & Kazerouni, 2013).

However, the efficacy of local Indonesian honey such

as Sumbawa forest honey has not been widely

studied. This study is important because the

composition and function of honey are influenced by

the different types of plants, climates, and

environmental conditions within which the honey is

produced (Sumarlin et al., 2014).

The results of this study indicate that from day 1

to day 21

, the mean percentage of wound length

following topical application of Sumbawa forest

honey is consistently smaller than the mean

percentage of wound length in the group with

application of povidone iodine 10% as well as in the

untreated group. It can be interpreted that the wound

closure occurred faster after topical application of

Sumbawa forest honey. This is in line with Ghaderi’s

study (2004) which showed that the mean length of

the wound edge of the group of mice smeared with

honey were smaller than the control group (Ghaderi

& Afshar, 2004). In the inflammatory phase that lasts

between day 1 and 4, the application of honey

provides an anti-inflammatory effect that reduces

edema and necrosis, and decreases infiltration of

polymorphonuclear (PMN) and mononuclear (MN)

cells. In addition, previous studies have shown that

honey can accelerate re-epithelization, stimulate

angiogenesis and improve wound contraction by

increasing collagen synthesis and the degree of cross-

linking of collagen in granulation tissue in the

proliferative phase (Yaghoobi & Kazeroune, 2013;

Al-Waili et al., 2011).

There are three major properties of honey that

play roles in accelerating wound healing. First, its

high sugar content causes high osmolarity thus it

inhibits bacterial and fungal growth in open wounds.

Second, the presence of glucose oxidase enzyme that

can convert into hydrogen peroxide, which acts as an

antiseptic. Third, the content of various enzymes in

bee pollen and propolis can stimulate the growth of

new tissues. In addition, honey also contains essential

oils, flavonoids and polyphenols and vitamin C that

serve as antioxidants (Ghaderi& Afshar, 2004; Al-

Waili et al., 2011; Molan & Rhodes, 2015).

It is necessary to observe the effects of Sumbawa

forest honey on other aspects of wound healing such

as microbiological and histological aspects. Further

study is needed to determine the concentration of

Sumbawa forest honey that is most effective for

wound healing.

5 CONCLUSION

The topical application of Sumbawa forest honey can

accelerate the healing of incision wound on BALB /

c male mice.

REFERENCES

Al-Waili, N., Salom, K., Al-Ghamdi, A.A., 2011. Honey

for wound healing, ulcers, and burns; data supporting

its use in clinical practice. The Scientific World Journal

11, 766–87. doi:10.1100/tsw.2011.78

Ghaderi, R., Afshar, M., 2004. Topical application of honey

for treatment of skin wound in mice. Iranian Journal of

Medical Sciences 29, 185–188.

Julmansyah. 2009. Alam Sumbawa: Menjaga Identitas

Madu Sumbawa. Sumbawa: Jaringan Madu Hutan

Sumbawa.

Maryani, R., Alviya, I., Budiarifanti, V., Salmiah, M. 2013.

Melestarikan Lanskap Hutan Sumbawa melalui

Penguatan Kelompok Tani Madu Hutan. Kementrian

Kehutanan Pusat Penelitian dan Pengembangan

Perubahan Iklim dan Kebijakan; 7: 1–4.

Medhi, B., Puri, A., Upadhyay, S., Kaman, L., 2008.

Topical application of honey in the treatment of wound

healing: A metaanalysis. JK Science 10, 166–169.

Molan, P., Rhodes, T., 2015. Honey: A biologic wound

dressing. Wounds 27, 141–151.

Sumarlin, L.O., Muawanah, A., Wardhani, P. 2014.

Anticancer and Antioxidant Activity of Honey in the

Market Local Indonesia. Jurnal Ilmu Pertanian

Indonesia (JIPI); 19(3): 136–144.

Yaghoobi, R., Kazerouni, A., kazerouni, O., 2013.

Evidence for clinical use of honey in wound healing as

an anti-bacterial, anti-inflammatory

RCD 2018 - The 23rd Regional Conference of Dermatology 2018

anti-oxidant and anti-viral agent: A review. Jundishapur

Journal of Natural Pharmaceutical Products.

doi:10.17795/jjnpp-9487

Zulhawa, D. 2010. Daya Hambat Madu Sumbawa Terhadap

Pertumbuhan Kuman Staphylococcus aureus Isolat

Infeksi Luka Operasi RS Islam Amal Sehat Sragen.

Surakarta.

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The Efﬁcacy of Topical Application of Sumbawa Forest Honey for Wound Healing: Study on Incision Wound of Balb/C Male Mice