Experience with the use of sugar paste dressing followed by reconstruction of sacral pressure sore with V-Y flap: A reliable solution for a major problem

Abstract

Pressure sore is a complication in paraplegic/quadriplegic patients. Despite advances in reconstruction techniques, sacral pressure sores are still a challenge to the orthopaedic surgeon, because of long hospital stay resulting into the situation where pressure sores are in evitable for ambulatory patients too. Development of pressure sores makes treatment/rehabilitation difficult and delays treatment options. Additionally, untreated sores cause complications, e.g. death and recurrence after surgery. Attention has been focused on aggressive dressing of the deep sores with use of sugar paste. Once granulation tissue had filled a sore cavity, a surgical closure using V-Y flaps were considered a method providing better treatment results. This study was conducted on 14 patients (10 males and 4 females) with sacral pressure sores in age group of 35 to 80 years. After initial debridement and removal of tissues of doubtful viability, culture and sensitivity were done in all cases. Wounds were packed with sugar paste for 5 to 14 days or till cavity is filled by granulation tissue. Bilateral V-Y myocutaneous flaps were used in 13 cases. Wound gaping occurred in 1 due to failure of a unilateral rotational flap and secondary bilateral V-Y myocutaneous flaps were needed. Suction drains retained for 7 to 10 days and pressure bearing on sores sites was avoided till complete healing. Superficial infection occurred in 3 cases which responded to suction and dressings. In our experience, the use of sugar paste dressing as a preprocedure to V-Y flap covering operation is a reliable options in management of infected deep sacral pressure sore.

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“…Stress due to high osmotic can damage cell wall permeability, and eventually, the bacteria will die (O'Connell & Wardlaw, 2011). The wound in moist conditions can prevent bacterial colonization (Ruhullah et al, 2013).…”

WHAM evidence summary: sugar dressing for wound healing and treating wound infection in resource limited settings

“…It is readily accessible at a very low cost in most geographic regions. In its granular/crystalized form, sugar consists of glucose and fructose, bound together to form sucrose (a disaccharide) 13,26 . Sugar is present as a monosaccharide in other natural treatments, including honey, saps and fruit 22 .…”

“…This also leads to mechanical debridement through slough adherence to the sugar dressing for removal without damage to healthy tissue 1,3,22 . In addition, sugar's hygroscopic property contributes to autolytic debridement 13 , and reduction of edema in the wound bed and surrounding tissues 1,13 . Sugar increases osmolality of the wound environment, which influences water level activity.…”

“…This mechanism attracts lymphocytes and macrophages to the wound bed 1 , and can inhibit the growth of bacteria 5,7,25,26 . Sugar also releases hydrogen peroxide at low, non-toxic levels, which further inhibits bacteria activity 7,13,27 . Invitro studies have demonstrated sugar's activity against a range of bacteria, including S. aureus, P aeruginosa, S. faecalis, E. coli, K. pneumoniae, and C. albicans 5,8,25 ; and this was supported in an in-vivo study reported below 4 .…”

“…Level 1 evidence 3, 4 at high risk of bias showed sugar dressing was associated with acceptable wound healing rates 3,4 and reduction in wound infection 4 , but might not be as effective as Edinburgh University Solution of Lime (EUSOL) 3 or honey 4 , which are both commonly used in settings with limited resources. Level 3 5-7 and 4 8-15 evidence at moderate or high risk of bias provided evidence that sugar dressing might promote healing 5,6,8,9,[11][12][13][14][15] , improve the wound bed tissue 5,9,[13][14][15] , and reduce bacterial infection 6, 12-15 , wound pain 5 , and wound malodour 7,10 .…”