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| UNIQUE THERAPIES FOR DIFFICULT WOUNDS Seven to 8 psi of lavage pressure can diminish wound bacteria by greater than 75%.1 SUGAR For centuries granulated sugar has been used to treat wounds, such as mechanical injuries, ulcers, and burns. Sugar is a desirable treatment because it:2 UÊ >ÃÊ>nÌiL>VÌiÀi>lÊivviVÌÃÊ>}>inÃÌÊoÀ}>niÃmÃ]ÊÃÕVhÊ as Escherichia coli, Pseudomonas aeruginosa, and Streptococcus canis UÊ m«ÀoÛiÃÊÃÕ«iÀviVi>lÊ`iLÀi`iminÌ UÊ nh>nViÃÊÌiÃÃÕiÊ}ÀoÜÌhÊ>n`Êi«iÌhili>liâ>Ìion UÊ*ÀomoÌiÃÊÀ>«i`ÊÜoÕn`Êhi>lin} UÊ >ÞÊ`iVÀi>ÃiÊm>lo`oÀÊvÀomÊÌhiÊÜoÕn` UÊ ÃÊiniÝ«inÃiÛiÊ>n`Êi>ÃÞÊÌoÊoLÌ>in° Mechanism of Action Sugar has high osmolality, which draws water and nutrient-rich lymph into the wound, nourishing the regenerating tissues. In addition, the high osmotic stress caused by sugar on bacteria interferes with cell signaling and cell wall permeability, leading to bac- 1 2 terial death. Bacterial cells are affected by osmostic stress because they rapidly divide, which makes them more susceptible to metabolic attacks. Sugar also attracts macrophages and forms a protective layer ovÊ «ÀoÌiinÊ LÞÊ >VViliÀ>Ìin}Ê ÃloÕ}hin}Ê ovÊ `iÛiÌ>liâi`Ê tissue and allowing a granulation bed to form. This protein layer is created from inflammatory cells and sloughing dead cells. Application 1. Lavage & Debridement: See Wound Preparation, page 11. Due to sugar’s debriding properties, grossly contaminated wounds may not need super- ficial debridement. The wound represented in the figures below typically receives 1 liter of lavage at initial cleaning and 500 to 1000 mL of lavage at each bandage change. 2. Application: A copious layer (at least 1–2 cm thick) of sugar should be applied to the entire wound, 3 Figure 1. Initial presentation of a degloving and crushing injury of the dorsal metatarsus infected with Pseudomonas. Figure 2. After cleaning the wound, a thick layer of granulated sugar was poured over the entire wound. Figure 3. Large sterile cotton gauze was used to hold the sugar on the distal wound. 4 5 Figure 4. The wound was wrapped to ensure the sugar stayed in place and covered the entire wound. The primary layer must be sterile and very absorptive. Figure 5. The secondary layer should bulk the bandage to prevent strikethrough. An aluminum rod was incorporated in this layer to support the hock, which was unstable. 12 Today’s Veterinary Practice July/August 2011