Also see:
Theurapeutic Honey – Cancer and Wound Healing
Wound Healing: Topical Omega -9 is Superior to the “Essential Fatty Acids”
Sugar (Sucrose) Restrains the Stress Response
Thumbs Up: Fructose
The Sugar Cure
“Applying glucose and insulin topically to the wound, it heals quickly. The very old practice of treating deep wounds with honey or granulated sugar has been studied in controlled situations, including the treatment of diabetic ulcers, infected deep wounds following heart surgery, and wounds of lepers. The treatment eradicates bacterial infections better than some antiseptics, and accelerates healing without scarring, or with minimal scarring. The sugar regulates the communication between cells, and optimizes the synthesis of collagen and extracellular matrix.” -Ray Peat, PhD
J Wound Care. 2002 Feb;11(2):53-5.
Why do some cavity wounds treated with honey or sugar paste heal without scarring?
Topham J.
As well as having antimicrobial properties, honey and sugar paste are associated with scarless healing in some cavity wounds. This article uses evidence to suggest why these products can modify excessive collagen production to prevent scarring.
J Tissue Viability. 2000 Jul;10(3):86-9.
Sugar for wounds.
Topham J.
Sugar in its pure form, or incorporated into a paste containing an adhesive hydropolymer (gum), is a non-toxic treatment for a variety of wounds. Not only does it provide a suitable clean environment for angiogenesis to take place, but it will debride the wound surface and reduce odour. The presence of an adhesive hydropolymer seems to prevent hypergranulation, scarring and contraction.
Lancet. 1985 Jul 27;2(8448):180-4.
Use of granulated sugar in treatment of open mediastinitis after cardiac surgery.
Trouillet JL, Chastre J, Fagon JY, Pierre J, Domart Y, Gibert C.
19 critically ill adults with acute mediastinitis after cardiac surgery were treated with granulated sugar, either directly (11 patients) or after failure of continuous irrigation (8 patients). Mediastinal tissue cultures were positive in 18 patients. Packing the mediastinal cavity with granulated sugar every 3 or 4 h resulted in near-complete debridement of the wound and rapid formation of granulation tissue in all patients and sterilisation of the wound after an average of 7.6 days. Dressings were easy and painless to change. 5/19 (26%) patients died before discharge, but none because of wound complications. The rest were discharged on average 54.2 days (range 29-120) after initial debridement of the wound; 11 underwent secondary surgical closure of the wound and in 3 the wound healed by granulation tissue formation alone. No recurrence of sternal infection has occurred after a mean follow-up of 8.2 months (range 3 to 17).
Sugar to Reduce a Prolapsed Ileostomy
N Engl J Med 2011; 364:1855May 12, 2011DOI: 10.1056/NEJMicm1012908
Sugar to Reduce a Prolapsed Ileostomy
Alexandra R.M.L. Brandt, M.D., and Olaf Schouten, M.D., Ph.D.
A 62-year-old man presented to the emergency department with a prolapsed ileostomy (Panel A). He had undergone ileostomy 25 months earlier for the treatment of mesenteric ischemia requiring an extended right hemicolectomy. The prolapse had occurred 12 hours before presentation, with no known cause. An attempt at manual reduction of the prolapse was unsuccessful. The patient’s severe coexisting cardiovascular and respiratory conditions made the use of general anesthesia and surgical reduction a risky therapeutic option. As has been previously described in the management of anal prolapse, bovine uterine prolapse, and (rarely) ileostomal prolapse, plain granulated sugar was applied to the mucosa of the prolapsed ileum to promote the osmotic shift of fluid out of the edematous tissue (Panel B). Within 2 minutes, the edema had diminished sufficiently to allow spontaneous reduction of the prolapsed ileum (Panel C). Twenty-four hours later, endoscopic evaluation revealed mild ischemia of the lower portion of the ileum, which required no treatment. The patient was discharged the following day. Ileostomal prolapse did not recur during 6 months of follow-up.
Orv Hetil. 1990 Apr 1;131(13):691-5.
[Topical treatment using granulated sugar in advanced mediastinitis following open heart surgery].
[Article in Hungarian]
Szerafin T, Vaszily M, Péterffy A.
The complications caused by infection were examined prospectively in the case of 1164 patients who had undergone open heart operation. Postoperative mediastinitis occurred in 15 cases (1.3%). Owing to mediastinal infection verified by bacteriological findings all patients had to undergo surgical intervention. Ten patients were treated by closed mediastinal irrigation. This method was effective in the case of five patients. Granulated sugar treatment was locally applied in five cases because of an infection, relapsing in spite of a closed treatment, and in four cases primarily, because of advanced mediastinitis and sternum osteomyelitis. With the mediastinal cavity being filled with granulated sugar twice a day, a rapid emptying of the wound and granulation tissue formation was observed in all patients. Redressing was easy and painless. Out of the 9 patients treated by granulated sugar three died before being discharged, but none of the deaths were due to wound complications. The rest of the patients were discharged cured averagely after 91.6 +/- 8.0 days. During the average 22 months’ follow up period recurrence of sternal infection was not observed in the group treated by granulated sugar, while out of the 5 patients cured by closed mediastinal irrigation two had to undergo another operation after a few months because of the formation of sternal fistula. The authors consider the granulated sugar treatment to be an effective method in the treatment of obstinate and advanced mediastinal infections.
J Cardiovasc Surg (Torino). 2000 Oct;41(5):715-9.
Treatment of recurrent postoperative mediastinitis with granulated sugar.
De Feo M, Gregorio R, Renzulli A, Ismeno G, Romano GP, Cotrufo M.
BACKGROUND:
The authors report their experience with granulated sugar as dressing technique in the treatment of postoperative mediastinitis refractory to a closed irrigation system.
METHODS:
Between January 1990 and January 1998, mediastinitis developed in 61 (0,93%) of 6521 patients who had undergone open heart surgery. Diagnosis of sternal infections was based on wound tenderness, drainage, cellulitis, fever associated with sternal instability. All of them were initially treated with surgical debridement and closed chest irrigation. Nine patients with postcardiotomy mediastinitis refractory to closed chest irrigation underwent open dressing with granulated sugar. All of them were febrile with leukocytosis and positive wound cultures.
RESULTS:
Bacteria isolated were staphylococcus aureus in 6 cases, staphylococcus epidermidis in 2 and pseudomonas in 1. Redebridement was performed in all cases and the wound was filled with granulated sugar four times a day. Fever ceased within 4.3+/-1.3 days from the beginning of treatment and WBC became normal after 6.6+/-1.6 days. Three patients had hyperbaric therapy as associated treatment. Complete wound healing was achieved in 58.8+/-32.9 days (three patients underwent successful pectoralis muscle flaps).
CONCLUSIONS:
Sugar treatment is a reasonable and effective option in patients with mediastinitis refractory to closed irrigation treatment. It may be used either as primary treatment or as a bridge to pectoralis muscle flaps.
Scand J Thorac Cardiovasc Surg. 1991;25(1):77-80.
Granulated sugar treatment of severe mediastinitis after open-heart surgery.
Szerafin T, Vaszily M, Péterffy A.
Fifteen cases of mediastinitis developing after 1,164 open-heart operations (incidence 1.3%) were analyzed. Closed mediastinal irrigation was used as primary therapy in ten cases and led to complete healing in five. Granulated sugar treatment was given primarily to four patients and to five others after failure of closed mediastinal irrigation. The sugar treatment was successful in six patients with hospital stay averaging 91.6 +/- 8 days. The three other patients in this group died before discharge from hospital. During 22-month follow-up there was no recurrence of mediastinitis in the granulated sugar group, but reoperation was necessitated by sternal fistula in two of the patients with closed mediastinal irrigation. Granulated sugar treatment is effective in refractory, severe mediastinal infections.
South Med J. 1981 Nov;74(11):1329-35.
Use of sugar and povidone-iodine to enhance wound healing: five year’s experience.
Knutson RA, Merbitz LA, Creekmore MA, Snipes HG.
Over a 56-month period (January 1976 to August 1980), we treated 605 patients for wounds, burns, and ulcers with granulated sugar and povidone-iodine. Rapid healing ensued, due to a reduction in bacterial contamination, rapid debridement of eschar, probable nourishment of surface cells, filling of defects with granulation tissue, and covering of granulation tissue with epithelium. The requirements for skin grafting and antibiotics were greatly reduced, as were hospital costs for wound, burn, and ulcer care.
BMJ Case Rep. 2013 Feb 28;2013. pii: bcr2012007565. doi: 10.1136/bcr-2012-007565.
Granulated sugar to reduce an incarcerated prolapsed defunctioning ileostomy.
Mohammed O, West M, Chandrasekar R.
This case report discusses the successful application of granulated sugar to reduce a prolapsed ileostomy thereby eliminating the need for an emergency surgery.
Tech Coloproctol. 2010 Sep;14(3):269-71. doi: 10.1007/s10151-009-0507-1. Epub 2009 Jul 11.
Reduction of an incarcerated, prolapsed ileostomy with the assistance of sugar as a desiccant.
Shapiro R, Chin EH, Steinhagen RM.
Prolapse is a well-described complication after ileostomy or colostomy, and is typically asymptomatic and easily reduced. Acute incarceration of a prolapsed stoma is a rare event, however. A patient presented with an incarcerated, prolapsed ileostomy causing small bowel obstruction and stomal ischemia. Successful reduction was performed with the assistance of sugar as a desiccant. Incarceration of a prolapsed ileostomy is highly atypical, but can be approached in a similar manner to an incarcerated rectal prolapse. Successful reduction can prevent an emergent operation, allowing for medical optimization and elective surgical treatment if necessary.
J Diabetes Sci Technol. 2010 Sep 1;4(5):1139-45.
Use of sugar on the healing of diabetic ulcers: a review.
Biswas A, Bharara M, Hurst C, Gruessner R, Armstrong D, Rilo H.
With the advent of several innovative wound care management tools, the choice of products and treatment modalities available to clinicians continues to expand. High costs associated with wound care, especially diabetic foot wounds, make it important for clinician scientists to research alternative therapies and optimally incorporate them into wound care protocols appropriately. This article reviews using sugar as a treatment option in diabetic foot care and provides a guide to its appropriate use in healing foot ulcers. In addition to a clinical case study, the physiological significance and advantages of sugar are discussed.
J Exp Pathol (Oxford). 1990 Apr;71(2):155-70.
A controlled model of moist wound healing: comparison between semi-permeable film, antiseptics and sugar paste.
Archer HG, Barnett S, Irving S, Middleton KR, Seal DV.
An established wound model in the pig has been modified using a Stomahesive ring to enable study of the effects of fluids used in wound care. Full thickness wounds (up to 9 mm deep) were treated with the substances under test. Each application was held in place with a Stomahesive flange, the inner part of which had been excised as far as the hard plastic ring. All dressings were then covered with OpSite which allowed gaseous exchange whilst retaining treatment fluids and secretions. Wounds were treated immediately and at 2 and 4 days. The experiment was terminated after 7 days and the whole wound, with dressing, was excised for histological examination. The wounds covered with OpSite alone and those treated with sugar paste under Opsite were found to be infilled with granulation tissue over which epidermal migration was taking place. Those wounds which had been packed with gauze, to which had been added one of the following: chlorhexidine gluconate 0.2%, Irgasan 0.2%, povidone iodine 0.8% or EUSOL half-strength, showed delayed healing in that less infilling had taken place over the same time period. This delay could be attributed to the nature of the chemicals used and/or the influence of gauze packing. This delay in the healing of wounds treated with chemical agents was least with EUSOL half-strength and greatest with chlorhexidine. No toxic effects were observed with sugar paste which may be preferable to antiseptics for the management of dirty or infected wounds.
Pathogenesis of Wound and Biomaterial-Associated Infections 1990, pp 159-162
Development of a Semi-Synthetic Sugar Paste for Promoting Healing of Infected Wounds
Keith R. Middleton, David V. Seal
Pastes comprising primarily sucrose and polyethylene glycol 400 have been used with good effect to treat infected and malodorous wounds in many patients. The pastes have good in vitro antimicrobial activity and demonstrated no toxic effects in full thickness wounds in a controlled trial in a pig model. Other commonly used antiseptics that were tested showed impairment of wound healing. Sugar paste is inexpensive and should be considered for the treatment of infected wounds in preference to other antiseptics.
Ann Emerg Med. 1997 Sep;30(3):347-9.
Sucrose as an aid to manual reduction of incarcerated rectal prolapse.
Coburn WM 3rd, Russell MA, Hofstetter WL.
Incarcerated rectal prolapse is a potential surgical emergency. We report a case in which a simple but effective technique involving the desiccating effect of granulated sugar (sucrose) was used to aid the manual reduction of prolapsed but viable rectal tissue.
Dis Colon Rectum. 1991 May;34(5):416-8.
Sugar in the reduction of incarcerated prolapsed bowel. Report of two cases.
Myers JO, Rothenberger DA.
Incarcerated, prolapsed rectum, colostomies, and ileostomies, when viable, may be reduced using ordinary table sugar. The placing of sugar granules on the incarcerated bowel results in a decrease in tissue edema and spontaneous bowel reduction. The technique, case reports, and a review of the literature are herein reported.
J Wound Care. 2011 May;20(5):206, 208, 210 passim.
Use of granulated sugar therapy in the management of sloughy or necrotic wounds: a pilot study.
Murandu M, Webber MA, Simms MH, Dealey C.
” Preliminary data suggest that sugar is an effective wound cleansing and is safe to use in patients with insulin-dependent diabetes. In vitro studies demonstrate that sugar inhibits bacterial growth.”
Microb Pathog. 2012 Jan;52(1):85-91. doi: 10.1016/j.micpath.2011.10.008. Epub 2011 Nov 4.
Sugar inhibits the production of the toxins that trigger clostridial gas gangrene.
Méndez MB, Goñi A, Ramirez W, Grau RR.
“The present results are analyzed in the context of the role of CcpA for the development and aggressiveness of clostridial gas gangrene and the well-known, although poorly understood, anti-infective and wound healing effects of sugars and related substances.”
Arch Dermatol Res. 2007 Nov;299(9):449-56. Epub 2007 Aug 7.
Mixture of sugar and povidone-iodine stimulates healing of MRSA-infected skin ulcers on db/db mice.
Shi CM, Nakao H, Yamazaki M, Tsuboi R, Ogawa H.
“These results indicate that wounding on db/db mice provides a useful animal model of bacterial skin infections, and that a 70% sugar and 3% povidone-iodine paste is an effective topical agent for the treatment of diabetic skin ulcers.”
Arch Dermatol Res. 2006 Sep;298(4):175-82. Epub 2006 Jul 22.
Mixture of sugar and povidone–iodine stimulates wound healing by activating keratinocytes and fibroblast functions.
Nakao H, Yamazaki M, Tsuboi R, Ogawa H.
“SP, the mixture of sugar and povidone–iodine, is likely to act on wounds not only as an antibiotic agent, but also as a modulator for keratinocytes and fibroblasts.”
Antimicrob Agents Chemother. 1983 May;23(5):766-73.
In vitro study of bacterial growth inhibition in concentrated sugar solutions: microbiological basis for the use of sugar in treating infected wounds.
Chirife J, Herszage L, Joseph A, Kohn ES.
The use of sugar for the treatment of infected wounds was investigated in in vitro experiments with bacteria pathogenic to humans, such as Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Staphylococcus aureus. Studies showed that solutions of appropriate sugar concentration incubated at pH 7.0 and 35 degrees C were lethal to the bacterial species studied. On the basis of these results, it is proposed that an important function of sugar in the treatment of infected wounds is to create an environment of low water activity (aw), which inhibits or stresses bacterial growth.
Int Surg. 1984 Oct-Dec;69(4):308.
Sugar in the treatment of infected surgical wounds.
Rahal F, Mimica IM, Pereira V, Athié E.
Forty-two patients with infected wounds were treated with common sugar. In all cases, the infections cleared within five to 30 days.
More:
Merck Veterinary Manual: Initial Wound Treatment
“Sugar Dressings
Sugar has been used as an inexpensive wound dressing for over 3 centuries. The use of sugar is based on its high osmolality, which draws fluid out of the wound. Reducing water in the wound inhibits the growth of bacteria. The use of sugar also aids in the debridement of necrotic tissue, while preserving viable tissue. Granulated sugar is placed into the wound cavity in a layer 1-cm thick and covered with a thick dressing to absorb fluid drawn from the wound. The sugar dressing should be changed once or twice daily or more frequently as needed (eg, whenever “strike-through” is seen on the bandage). During the bandage change, the wound should be liberally lavaged with warm saline or tap water. Sugar dressings may be used until granulation tissue is seen. Once all infection is resolved, the wound may be closed or allowed to epithelize. Because a large volume of fluid can be removed from the wound, the patient’s hemodynamic and hydration status must be monitored and treated accordingly. Hypovolemia and low colloid osmotic pressure are complications that may be associated with this therapy.”
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Sweet!
Awesome, thanks!