Granulated sugar treatment for leg ulcers: a case report

Murandu, Moses DonaldAuthor Information

26.1

. Primary Health Care (2014+)

(Feb 2016): 26.

Abstract
The use of sugar in the treatment of wounds dates back to Ancient Egypt. This article begins with
a summary of that history and, in the case study that follows, a patient describes his 13-year
experience of living with leg ulcers. The patient explains the challenges these ulcers have
brought to his day-to-day life and the particular problems he encountered with pain management.
He discusses different approaches by doctors and district nurses to manage the ulcers and how,
by chance, a newspaper article led to a meeting with a PhD student researching sugar and wound
care - a meeting that was to lead to a new lease of life for the patient.

Full Text
SUGAR WAS used as a wound-dressing product in Ancient Egypt and Mesopotamia ( Majno
1975 , Selwyn and Durodie 1985 ). Furthermore, Galen of ancient Rome reportedly used sugar as
a wound care product and noted anti-putrefactive properties (Forest 1982, Petrosillo 2008 ), and
in early modern times its use is mentioned by German writers, including Sculteus in 1679, who
used finely powdered sugar to clean wounds ( Pieper and Caliri 2003 ), and Zoinin in 1714, who
highlighted the value of sugar for promoting wound and ulcer healing ( Fischer 1885 , Dawson
1996). Today, it is used as a wound dressing in many parts of the world ( Mphande et al 2007 ,
Chiwenga et al 2009 ). Sugar has been observed to have antibacterial properties in vitro and in
clinical care ( Knutson et al 1981 , Chirife et al 1993 ), probably through an osmotic effect that
reduces the available water on the wound surface ( Chirife et al 1982 ). The first-person case
report that follows in this article highlights the effectiveness of this method of wound care.
Case study
I am a 66-year-old male who was being treated for non-healing leg ulcers. I needed crutches and
a wheelchair to get around.
Aetiology as understood by patient I found a spot on my leg, which a locum doctor
dismissively diagnosed as a fleabite. Over the following weeks both legs, from below the knees
to the tops of my feet, became covered with lesions/ulcers of various sizes. Every time one sore
spot eventually disappeared, another one would arise. I could not walk without support and was
in agonising pain constantly.

Effect on daily living The impact on my life was shattering. I could no longer work, I could no
longer drive. I went from being the member of the family to whom everyone came for help to
being the one who was now dependent on them.
Life revolved around my legs. When making arrangements to go anywhere, the conversation
included 'Wait a minute, is that a leg clinic day? Or a district nurse's visiting day? A hospital
appointment day?' Even the day before a change of dressings had to be taken into account, if the
bandages were particularly 'gungey' and odorous. Who likes sitting near someone who smells?
Coping with pain I did not go out as much as I used to, as I did not feel up to it. Thank goodness
I had friends and a family to keep me going. I was prescribed drugs to help with the pain; slowrelease morphine tablets and oral morphine liquid, called Oramorph, if things got really bad. But
with all the medication I soon became depressed and angry. My life had crashed through the
floor. How could I get through this? And how many ulcer patients must be feeling the same way?
Initial treatment Every few months I would visit the leg ulcer clinic at the Countess of Chester
Hospital. The team there was brilliant and very supportive, and so was the consultant surgeon.
This is where suggestions for changes in treatments, for the district nurses to try, would originate.
Some were better than others. Mepilex pads, zinc pads, silver-dressing pads, charcoal-dressing
pads to manage the odour, four-layer compression bandages - every other new dressing available
and not yet used, plus numerous creams, ointments and gels. You name it, the team tried it.
I got into a routine of sorts. Initially, the district nurses would visit once a week to attend to my
legs. This later increased to twice weekly. I endured the variety of treatments in the search to find
a solution. For a while I had to place each leg into a bowl or bucket of water to help remove the
blood-soaked bandages. I would have to brace myself as I knew the pain would be agonising as
the dressings were removed - along with my skin and flesh.
One clear memory I have is of a young nurse wiping away tears as she did the job. These visits
(but not the pain) became a welcome highlight in my life.
Quest for help The consultant suggested that a referral to the specialist hospital in the county for
a medical review might help my situation and, possibly, produce a solution. So I went. I lay on a
bed while several doctors came, prodded and poked my legs, asked questions and then left.
Result? My legs were very bad. But they could not suggest a cure.
One consultant asked me how bad my level of pain was. I said that it could not be any worse
than removing my leg. My life then veered off into a direction I did not expect.
An appointment with a doctor in the psychiatry department had been made. It was an anxious
time. I had to sit in the central waiting area. Then a nurse shouted out: 'Denis for the psychiatry
department.' It was awful. No discretion or patient confidentiality. Then probing questions were
asked. Another stressful period was endured before I was given the outcome: I was normal. I
now warn people to be careful what you say in desperation to healthcare professionals.

There is another treatment experience indelibly printed on my memory. I was taken down some
long, dimly lit corridors to a room that looked very clinical - almost like a torture chamber. The
staff asked me to strip down to my underpants. Then I was asked to sit in a bath filled with
enough water to cover my legs.
Surrounding the bath there were electrical panels with lots of dials. I worked out what was going
to happen next. They connected wires to my legs and sent electricity through them, turning the
dials to increase the voltage. I was told that this was to check for circulation damage in my legs.
These healthcare professionals were so uncaring - I thought they regarded me as a piece of meat
- and not at all like the lovely nurses downstairs in the leg ulcer clinic.
Resigned to living with leg ulcers Over the years I learned to live with my situation, but I could
not accept that it would be forever. Then one day I spotted a small article in a national
newspaper.
The item was about a PhD student who was a senior lecturer in adult nursing at a university in
the West Midlands and his pioneering sugar treatment. It mentioned that the student originated
from Zimbabwe and that this type of wound-care healing system was used by his father at home
in Africa.
The student described a patient called John, a recipient of the sugar treatment at his local hospital
in Birmingham. John's wounds had not been healing, which meant that he could not have
prosthetic limbs fitted. The student had been asked to try his sugar treatment on him, and it had
worked.
Further quest for help After I had read the article, I decided to contact my GP in Ellesmere
Port. After a lengthy discussion, we checked the researcher's details and concluded that I should
contact him to discuss my situation. The researcher arranged to visit me on a date that would
coincide with the day I was seen by a district nurse day - on this occasion, the nurse who had
become upset while she changed my dressings.
On viewing my bare legs, the researcher told me that the sugar treatment could possibly help
heal my wounds and that it would not take too long to see the results, but he was not certain.
The sugar treatment was started by 'piping' a layer of gel around each ulcer. The gel was not
placed on the wounds, however, because it is meant only to keep the sugar in place, like a fence.
Then the researcher sprinkled the sugar directly onto the ulcer. Next, he placed an iodine patch
over the area and sprinkled a little more sugar over the patch. Finally, he placed an absorbent pad
over the sugar and secured it to my leg with a K-Lite bandage. Thereafter, the district nurses
changed my dressings every other day.
When the researcher next visited, at the end of the week, there were three district nurses present
to watch and learn about the procedure. It transpired that there had been some improvement in
my leg ulcers. The pain had subsided and the smell had gone. I did not want to get my hopes up,
but at least I could have a few hours of quality sleep.

By week three, word had spread around the district nurses, and when the researcher visited there
was standing room only. Again, there had been an improvement in my legs and no new
outbreaks.
In the fourth week, the researcher asked one of the student nurses to carry out the dressing
change. The student was hesitant at first but carried on, with the researcher encouraging and
supporting her. She did a perfect job.
After changing the dressings she felt proud of herself, and so did the district nurses on standby. I
presumed that this is what the researcher was aiming for: that all the district nurses would be able
to administer the sugar treatment.
Patient's understanding of the action of sugar Sugar draws water from a wound into a
dressing. Bacteria cannot survive without water, so applying sugar to a wound allows for
acceleration of the healing process, or kick-starts it where progress has stalled.
Final success After four weeks of alternate-day sugar treatment, my wounds had stopped
weeping.
I had begun walking around the house without much pain. I finally realised the condition of my
legs had improved when I could go on holiday without a wheelchair. The thrill of being able to
swim again in a pool was wonderful. It marked the beginning of a new, exciting quality of life
for me.
The effects of the sugar treatment on my leg ulcers over one month are shown in the three
pictures in Figure 1 .
Conclusion
So far, so good. The ulcers have not returned. Having spent years immobile, I have problems
with mobility and have to rely on a walking stick or crutches. The nerves in my legs are bad due
to neuropathy and I have to be careful not to overdo things.
I realised that I had taken aspects of life for granted when, for the first time in years, I decided to
go outside while wearing a pair of shoes. I asked my wife if she could get me a pair, but she
reminded me that I did not have any to put on because they had all been donated to charity. I had
not realised that something as minor as asking for a pair of shoes would have such a massive
effect on me.
I feel so lucky that I met the researcher with his sugar treatment when I did. It brought relief to
my leg ulcer misery. There are so many more people who could also benefit from this marvellous
treatment. It may not work for all patients, but it may be beneficial to try it.
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