Hrev_master Veins and Lymphatics 2017; volume 6:6652 Anti-infective effects of sugar-vaseline mixture on leg ulcers Claude Franceschi,1,2 Massimo Bricchi,2 Roberto Delfrate2 1Centre Marie Thérèse, Hopital Saint Joseph, Paris, France; 2Casa di Cura Figlie di San Camillo, Cremona, Italy Abstract Fifty patients affected of resistant leg ulcers where treated exclusively with a vaseline-glucose mixture in combination with an etiologic treatment. Neither addi- tional topical, systemic anti-infective drugs nor surgical debridement were applied. The dressing turnover rate was 6-7 days. A first bacteriological sampling was followed by a second one (40 days mean), which showed 100% sterilized ulcers. A complete scaring was achieved in 46 (92%) on average of 109 days of apply. This efficient, low cost, pain- less and quick treatment could proposed as a first line option. Introduction Leg ulcers are chronic wounds due to various causes (trauma, ischemia, venous hypertension, etc.) that do not heal within a normal period. Their healing depends not only on the etiological but also anti-infec- tive treatment because they are usually worsened and prolonged by superinfec- tions. For that reason, in the presence of fungal or bacterial infections, an appropri- ate anti-infective therapy is recommended. It consists of systemic and/or topical anti- infective therapies combined with or with- out surgical debridement. The anti-infective efficiency of the sugar is known.1-6 The anti- infective effect and scaring acceleration achieved by a specific mixture of glucose and vaseline without any additional anti- infective drugs or surgical debridement was studied in resistant leg ulcers. Materials and Methods Patients Mono centric open-label trial including 50 patients, female (n=32), male (n=18) mean age=65 years presenting leg ulcers not healed since more than 180 days of treatment in other care units. These patients were affected of various pathologies as traumatic, cardiac failure, venous insufficiency, lymph edema, ID and NO ID diabetes and treated with insulin, oral hypoglycemic, anticoagulants, antiplatelet drugs. They all were assessed with arterial, venous and lymphatic duplex ultrasounds in order to diagnose the vascular etiology of their ulcers then treat it specifically. In all patients a first swab bacteriologi- cal assessment at bottom line, then a second one within 30 to 60 days (mean=40 days) were performed (Table 1). Treatment The treatment was applied in an ambu- latory care unit and at home. A soft cleaning of the wound and necrotic debris was performed with neutral detergent as tap water. No surgical debride- ment was carried out.7 The dressing was applied over all the area of the ulcer. It was made of mixture of Glucose 60% and Vaseline 40% supported by pads (Figure 1). Vaseline was in 40% proportion in order to hold in place the glu- cose powder on the wound thanks to an ade- quate consistency of the mixture as well as providing a high concentration of glucose. Neither topical nor systemic antibiotics whatever the antibiogram result were applied.8 Neither foam nor any autolytic debriding materials were used whatever the moisture of the wound.9 The bandaging tightness was performed according to the etiology. The dressing turnover was once every 6-7 days. Results In Table 1 the bacteria assessed by pre- treatment swab assessment are given. All the ulcers were germ free at second sam- pling culture: 50/50 (100%). No pain, no side effects nor complication was noticed except some irritation of the surrounding skin. Surprisingly, no more bad smell was noticed when removing the dressing. The completely rate of healed ulcers was n=46 (92%). The healing time mean was 109 days (range: 36-182 days). Not healed but improved ulcers were n=4 (8%). Details are given in Table 2. Discussion The results regarding the anti-infective effect of sugar on wounds confirms many previous studies.1-5 A study has shown that sugar gave less good results than natural brown sugar.11 Nevertheless, the glucose was 60% in the mix while it is quite absent in refined and natural brown sugar made respectively of 99.8 and 95% of sucrose. Correspondence: Claude Franceschi, 21 quai Alphonse Le Gallo 92100, Boulogne, France. E-mail: claude.franceschi@gmail.com Key words: Ulcer; sugar; honey; anti-infective; debridment. Conflict of interest: the authors declare no potential conflict of interest. Received for publication: 17 February 2017. Revision received: 17 March 2017. Accepted for publication: 19 March 2017. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright C. Franceschi et al., 2017 Licensee PAGEPress, Italy Veins and Lymphatics 2017; 6:6652 doi:10.4081/vl.2017.6652 Table 2. Not healed ulcers rate. Not healed but improved ulcers at 182 days 4 (8%) Ulcer associated with osteomyelitis 1 Deep traumatic wound 1 Ulcer associated with diabetes and neuropathy 1 Arterio-venous mixed ulcer 1 Table 1. Germs identified at the first sam- pling. Bottom line culture No. Proteus mirabilis 2 Staphylococcus aureus 14 Escherichia coli 9 Citrobacter freundii 3 Staphylococcus epidermidis 11 Candida albicans 3 Streptococcus faecalis 7 Pseudomonas aeruginosa 1 [page 36] [Veins and Lymphatics 2017; 6:6652] No n c om me rci al us e o nly Article [Veins and Lymphatics 2017; 6:6652] [page 37] The honey also is different from the Vaseline-glucose mix because it contains Fructose: 38.2%, Glucose: 31.3%, Maltose: 7.1%, Sucrose: 1.3%.11 The healing time of the ulcers is more difficult to relate to the mixture alone because it depends also on the etiological treatment efficiency. So, the inefficiency of the previous treatments (ulcers lasting for more than 6 months) was not necessarily due to the superinfection but maybe to an inadequate etiological treat- ment. The venous ulcers were treated with compression and/or deep CHIVA,12 superfi- cial CHIVA,13 according to their hemody- namic configuration. Nevertheless, this study provides some news. The first one is the anti-infective efficiency of the vaseline- glucose mixture alone without antiseptics or antibiotics (topical or systemic). The second one is the efficiency of a single dressing whatever the moisture content. The third one is that contrary to the honey, the vase- line-glucose mix is not allergenic and its consistency, composition and glucose per- centage are constant. The fourth one is the absence of debridement, which not only permits a painless change of dressing but also leaves in place the new cells and pre- serves their growth. The fifth is the low cost due to the cheap material and the only one- week frequency of the dressing change. Conclusions The Vaseline-Glucose paste alone steril- izes the ulcers and promotes the healing when combined with the etiological treat- ment. Its low cost, efficiency, easy applica- tion could represent a first intention treat- ment. Further studies should be done in order to confirm these results but also to identify any other effect than anti-infective in the process of ulcer healing and scaring. References 1. Franceschi C, Passariello F. Low cost medications for venous ulcer. Sugar- Honey: an on line Vasculab Survey. Acta Phlebol 2009;10:41-4. 2. Topham J. Sugar paste and povidone- iodine in the treatment of wounds. J Wound Care 1996;5:364-5. 3. Topham J. Sugar for wounds. J Tissue Viab 2000;10:86-9. 4. De Feo M, Gregorio R, Renzulli A, et al. Treatment of recurrent postoperative mediastinitis with granulated sugar. J Cardiovasc Surg (Torino) 2000;41:715- 9. 5. Tanner AG, Owen ERTC, Seal DV. Successful treatment of chronically infected wounds with sugar paste. Eur J Clin Microbiol Infect Dis 1988;7:524-5. 6. Archer HG, Barnett S, Irving S, et al. A controlled model of moist wound heal- ing: comparison between semi-perme- able film, antiseptics and sugar paste. J Exp Pathol (Oxford) 1990;71:155-70. 7. Gethin G, Cowman S, Kolbach DN. Debridement for venous leg ulcers. Cochrane Database Syst Rev 2015; 14:9. 8. O’Meara S, Al-Kurdi D, Ologun Y, et al. Antibiotics and antiseptics for venous leg ulcers. Cochrane Database Syst Rev 2014;10:1. 9. O’Meara S, Martyn-St James M. Foam dressings for venous leg ulcers. Cochrane Database Syst Rev 2013; 31:5. 10. Léger L, Marchal J, Delaitre B, et al. Local treatment of wounds using bagasse. Phlebologie 1974;27(2):123-8. 11. White JW Jr, Doner LW. Honey compo- sition and properties - Beekeeping in the United States - Agriculture Handbook Number 335; Revised Octaober 1980, pp 82-91. Available from: http://beesource.com/ resources/ usda/honey-composition-and-proper- ties/ Accessed: 6 February 2011. 12. Zamboni P, Gianesini S. Surgical tech- nique for deep venous reflux suppres- sion in femoral vein duplication. EJVES Short Rep 2016;30:10-2. 13. Franceschi C, Zamboni P. Principles of venous haemodynamics. New York: Nova Science; 2010. Figure 1. Gauze compresses with a covering of Vaseline-glucose powder mix are applied on the ulcer before bandaging. No n c om me rci al us e o nly