THE USE OF SUGAR TO ENHANCE WOUND HEALING 
The use of antibiotics by the PHCP in the field has the inherent dangers of improper dosing and allergic reactions. The associated activities of preparing the N/antibiotic infusion and monitoring the N drip rates can be difficult during patient transport. Given these drawbacks, the use of granulated sugar for the treatment of infected wounds offers a practical, proven approach for wound care. The use of granulated sugar for treatment of infected wounds is recommended by some as a treatment of first choice.  Sugar has been called a nonspecific universal antimicrobial agent. 8 Based on its safety, ease of use, and availability, sugar therapy for the treatment of infected wounds is very applicable to the needs of the PHCP. 
Sugar and honey were used to treat the wounds of combatants thousands of years ago. Battlefield wounds in ancient Egypt were treated with a mixture of honey and lard packed daily into the wound and covered with muslin. Modern sugar therapy uses a combination of granulated sugar (sucrose) and povidone-iodine (PI) solution to enhance wound healing.
As with any traumatic wound, the wound is first irrigated and debrided. Hemostasis is obtained prior to the application of the sugar (PI) dressing since sugar can promote bleeding in a fresh wound. A wait of 24 to 48 hours before the application of sugar is not unusual. During this delay, a simple PI dressing is applied to the wound. Once bleeding is under control, deep wounds are treated by pouring granulated sugar into the wound, making sure to fill all cavities. The wound is then covered with a gauze sponge soaked in povidone-iodine solution. 
Superficial wounds are dressed with PI-soaked gauze sponges coated with approximately 0.65 cm thickness of sugar. In a few hours, the granulated sugar is dissolved into a "syrup" by body fluid drawn into the wound site. Since the effect of granulated sugar upon bacteria is based upon osmotic shock and withdrawal of water that is necessary for bacterial growth and reproduction, this diluted syrup has little antibacterial capacity and may aid rather than inhibit bacterial growth.
So to continually inhibit bacterial growth, the wound is cleaned with water and repacked at least one to four times daily (or as soon as the granular sugar becomes diluted) with more solute (sugar) to "reconcentrate" the aqueous solution in the environment of the bacteria. 
A variety of case reports provide amazing data supporting the use of sugar in treating infected wounds. Dr. Leon Herszage treated 120 cases of infected wounds and other superficial lesions with ordinary granulated sugar purchased in a supermarket. The sugar was not mixed with any anti-septic, and no antibiotics were used concurrently. Of these 120 cases, there was a 99.2 percent cure rate, with a time of cure varying between 9 days to 17 weeks. Odor and secretions from the wound usually diminished within 24 hours and disappeared in 72 to 96 hours from onset of treatment. 

Photo 23: Sugardyne is a commercially available sugar/povidone-iodine com- pound. Its proven antimicrobial properties make it particularly useful for infected wounds encountered in the field. (Sugardyne donated by Dr. RichardA. Knutson; distributed by Sugardyne Pharmaceuticals, INC.,Greenville, MS 38701.) 
Like Dr. Herszage, Dr. Richard A. Knutson has had very successful results from the use of sugar in wounds. One of Dr. Knutson's most unique cases is recounted as follows. 
A 93-year-old man was treated at Delta Medical Center for a fracture of his right hip. Concurrently, he received treatment for an old injury to his left leg, sustained 43 years earlier in 1936, when a tree had fallen on the leg while he was chopping wood. He had sustained an open fracture of the tibia and soft tissue loss to the leg anteriorly. Although the fracture had healed, bone remained exposed, surrounded by a chronic draining ulcer 20 cm x 8 cm overall. The patient was able to recall the various treatments used in attempts to heal the ulcer-iodoform, scarlet red, zinc oxide, nitrofurazone, sulfa, and a long list of antibiotics-all to no avail. He said that he had outlived six of the surgeons who had advised amputation. He was started on sugar/pI dressings, and then changed to treatment with sugar/PI compound as an inpatient. After hip surgery, the ulcer healed completely in 13 weeks. The ulcer defect filled completely, and skin grafting was not necessary.
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Dan