The aim of wound healing is to promote rapid wound closure and prevent excess scar formation. Honey has been used for cleansing and accelerating the healing of wounds for centuries. The use of honey to treat wounds on animals has been slow to come into acceptance. Application of manuka honey remain a viable option for enhancing the granulation tissue formation and early wound bed preparation before large wounds could be reconstructed with skin flaps. The flaps performed in the present study were flank and elbow rotational flap, transposition flap and caudal superficial epigastric flap, single pedicle and bipedicle advancement flaps. The flaps were selected based on the location and site of the wound. Subjective evaluation of wound healing based on the physical observations such as colour, odour and presence of exudates for recipient wound bed and skin flap respectively were performed. Clinical Photography, Wound Planimetry studies were evaluated. Additionally, hematological, bacteriological, biochemical, and histopathological evaluation were done for the recipient wound bed and skin flap. A subjective analysis of vascularity of the donor site was performed through Colour flow Doppler ultrasonography. Manuka honey decreased inflammatory edema, attraction of macrophages to further cleansed the wound, accelerated sloughing of devitalized tissue, provision of a local cellular energy source, and formation of a protective layer of protein over the wound and a healthy granulation bed that led to fibroblast recruitment, proliferation and matrix remodelling and ultimately good granulation and wound healing in the cases
