Randomised controlled feasibility trial on the use of medical grade honey following microvascular free tissue transfer to reduce the incidence of wound infection. 
The aim of this study was to assess the feasibility of using Leptospermum honey in a randomised trial to reduce the incidence of wound infection after microvascular free tissue reconstruction for cancer of the head and neck.  During the one-year study period 70 consecutive patients were admitted to the regional maxillofacial ward for free tissue reconstruction.  Of these, 56 (80%) consented to be randomised and 49 (70%) were actually randomised, 25 into the honey dressings group, and 24 into the conventional dressings group (control).  Six patients were missed when consent was required, 8 did not consent, and 7 who had given consent were missed at the randomisation stage in theatre.  Results of wound swabs were positive in 36% of the honey group and 38% of the control group.  Methicillin-resistant Staphylococcus aureus (MRSA) was found in 28% and 25%, respectively.  Of these, 38% were deemed to require intervention.  Honey dressings were acceptable to both patients and nurses.  There was a reduction (p<0.05) in duration of hospital stay in the honey group (median 12 days, IQR 10-21) compared with the control (median 18 days, IQR 13-28).  The cost of standard and honey dressings was similar.  This feasibility study has shown that a randomised controlled trial (RCT) is possible and that several hundreds of patients would be required to show a clinical benefit for honey.  Further research is needed to confirm a shorter duration of hospital admission and if so, whether this is due to more rapid healing.