Chapter 21: Table of Contents
Granulated sugar is easily available, inexpensive and it is an excellent topical dressing due to it’s bactericidal effects. The high osmolality of sugar creates an environment of low water activity in which bacterial growth is inhibited. Because of it’s high osmolality, sugar draws lymph fluid and macrophages to the wound bed which helps healing but also increases water activity in the wound and if fresh sugar is not added could eventually promote bacterial growth once the sugar becomes more of a syrup. Granulated sugar reportedly decreases inflammatory edema, accelerates sloughing of devitalized tissue, provides a source of energy for local tissues and promotes granulation tissue formation and epithelialization. Sugar is not absorbed systemically and does not cause hyperglycemia.
Excessive amounts (~1-2 cm thick) of granulated sugar are poured into the towel-dried wound bed following lavage and débridement. The bandage should be changed once to twice daily to prevent the granulated sugar turning into syrup, which could promote bacterial growth. One should aim to still find a little granulated sugar in the wound bed at the time of bandage change. A thick absorbent layer is necessary to prevent strike-through since sugar will draw a lot of fluid from the wound into the bandage. Because sugar bandages tend to adhere to the wound and provide some degree of tissue debridement (see wet-to-dry above), their use should be discontinued once granulation tissue appears in the wound bed. Non-adherent bandages or surgical wound closure should then be considered.
Sugar is typically used for 1-5 days in order to ‘sterilize’ the wound bed before granulation tissue formation occurs or to sterilize the superficial contamination of granulation tissue prior to planned surgical closure. Once a bed of granulation tissue is present, the wound’s resilience to infection increases significantly leading to superficial bacterial contamination rather than infection.