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Use of Jaggery in non healing wounds


Dr. Shantikumar D. Chivate, S.M. Shanbag, Dr. Ashok Koulgud, Dr. S.D.Pathak, S. Kanekar, Dr.Lande

Jeevan Jyot Hospital Naupada

THANE 400602

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Nonhealing wounds of I076 patients not responding to conventional treatment were healed by use of joggery dressing; during the period between I976 to 1995 at Employee State Insurance scheme Hospital  Mulund, Mumbai & Non healing wound care centre Thane. These patients belonged to age between 7 years to 88 years, 336 females and 740 males were suffering for the duration 3 months to 7 years. Infected foul smelling wounds became sterile and odorless after application of Joggery dressing. Slough was separated from the base & the margin of the non healing wounds which could be derided easily without pain & anaesthesia. Due to high osmotic   pressure created by joggery material wounds fluids diffuse into dressing & pale dry wounds were converted into wet & bright red granulated wounds. The wound fluids has stimulating effect on endothelial cell proliferation, nevovascularization fibroblasts & epithelial cells. Nonhealing wounds healed in varied period depending on size, depth of wound, loss of sensation in ulcer area & vascularity. In the follow up of 20 years period no carcinogenic effect was observed. Jiggery dressing has been proved to be excellent form of worth treatment for nonhealing wounds at worthless price.







0ne of the most troublesome problem a surgeon faces is failure of wound healing in any era, any culture and any country. Wounds just refuse to heal are common in tropics but are not uncommon in other parts of the world. In United Kingdom at least 150000 patients suffer from venous ulcers which fail to heal for months to years costing approximately 2500 pounds per ulcer per year (1) And leg ulcers are a major public health problem in United States estimating the  cost of the treatment which exceeds one biIIion dollar annually. (2) Many non specific wounds remain nonspecific even after microbiologica1, serological, heamatologica1 and histological detailed evaluation. Despite of systemic administration of suitable ent j bi of j c, una topica1 application of antimicrobials and antiseptics, the wounds still remain recalcitrant. In past one decade, more than 100 compounds known as peptides have been recognized those modulate the wound healing process. There has been explosion of the literatures on the cytokines and genes encoding for biosynthesis of many of these compounds. There are trials of topica1 application of the growth factors are going a11 over the world, spending a big fortune for nonhealng wounds. We have turned back the developmental clock and taken guide lines from grandmother's medical tips which are used as home remedy 'in western part of Mahgrashtra State in India. By burning a piece of jaggery on a flame hot melted jaggery vvas droped on wound. It used to be a horrible experience but still working. In technical consideration hot melted jaggery was sterile but due to burning which was producing hydrocarban would have a cause for malignancy in long use. The modified the procedure and method of application are used to avoid malignant changes.




During the period of 1976 to 1995 in Employee State Insurance Scheme Hospita1 Mulund Mumbai and Nonhealing wound Care Centre Thane, 1262 cases of non healing wounds were included for study. Criteria for 'inclusion in the study of non healng was adopted that those wounds which indicated no signs of healing even after haematologica1 and nutriention correction  of the deficiency, treatment for systemic disease Iike diabetics or uraemia, administration  of suitable  antibiotics and topical antimicrobial applications for 12 weekd. These wounds were persisted without clearance of slough, pale dry Stanulation or hyper granulation, nor epithelization and occasionally increase in the size  of wound. In some case wounds were started healing in the beginning but later on reparative process was arrested due to unknown reasons. Al I cases evaluated by general & the systemic examination. Wounds were divided into two groups, flat wounds and deep wounds for the measurement of the size. Fl at wounds were assessed by printing of impression of the wound on graph paper & occupied small & big squares were counted & area was calculated volume of deep wounds was determined by filling the wound with measured amount of saline. Al I these cases were investigated to study red & white ce11s, hemoglobin blood sugar, blood urea & serum protein levels. Every case was done for bacteriological was biopsied. The tissue culture evaluation & sensitivity for Jaggery was assessed in 130 cases, in the early phase of study, wounds in the proimity of the bone were studied for bone involvement radiologically. In I32 cases of non healing wound were treated by scooping & skin graft once in B4 cases and mu1tip1e times in 48 cases without desired effect in the past. Various antiseptic antibiotic ointments and detrimental agents were used (Table No.1) for healing of the wounds without any benefit.



0ne killo gram of Jaggery was dissolved in 500 ml. of water & thick viscous solution was prepared. Necessary gauze pieces tailored as per demand of the size  and shape of the wound were soaked in jiggery solution and autoclaved in a container, autoclaved jaggery gauze could be used for 72 hours and remaining unused could be re autoclaved and then used. Autoclaved jiggery solution of different concentrations was used directly in the cases depending on thick escar or slough. Ail wounds were cleaned with saline and the jaggery gauze pieces were        applied to the wound area only and bandaged. Dressing was changed every day. Assessment off size, of flat & deep wounds, slough amount, granulation and epithelization of the  wound was done weekly. Patients rntere treated i ndoor as wel I as outdoor pati ent, depend 1 ng on s i ze, and site of the wound. The slough which got separated and loosened from base and margins of the wound, was removed part by part from time to time without any assistance of anesthesia  without pain too. Completely healed patients were called for fo11ow-up routinely every week earlier for one month and six monthly later on for evaluation of recurrence and carci nogenic effect if any.



In 1262 patients of non healing wounds 186 cases indicated histological having specific infection and malignancy were deleted from the study. In 1076 cases of non healing wound of various types

(Tab1e No.2) were treated by topical application of jaggery dressing. It has included 336 females & 740 male patients belonging to age gr0up between 7 years to BB years average age was 42 years. They were suffering non healing of wound for the duration of 3 months to 7 year (Tab1e N0.3). Flat wounds measured in the range of 1 to 204 square centimeters and deep wound had volume from 20 to 563 cubic centimeters (Tab1e No.4). Different types of organisms were isolated and cultured from 130 cases in the early phase of the study (Table No.5) which indicated no difference in the response to jiggery when it was inoculated to test sensitivity on various cultures of the organisms. Since it failed to produce any sensitivity zone it was concluded that jaggery is merely active in vivo and not in vitro. The foul smelling wound became dour less and variegated discoloration of wound & its dressing rllas cleared in 3 to 5 days by the use of jaggery dressing. Adherent necrotic tissue and slough began to separate from margins and base of wound in first week and then quantity increased every day. The separated slough was removed effortlessly and wound was cleared in 2-3 weeks. 0ne week longer period was necessary to clear necrotic slough in the wounds due to radiation. The same time edema in the surrounding area of wound was reduced. Pale granulated wounds changed to bright red granulated, dryness was converted into wet wound due to diffusion of wound fluids through its base. Epithelisation of the wound began on an average period of 2-4 weeks. The jaggery dressing  e+€-.".n.ev-e'r-a-dhe-pe+t-".t.0 granulation, or epithe1ia1 tissue of the wound. In general duration required for wound healing was proportion to the size of the wound. But the diabetic wounds and tropic ulcers were exception to it. 0n fo11ow-up hypertrophic scars were present jn t2%cases and in no case carcinogenic changes were noted in 3 to 20 years of follow up details about various types of ulcers are as fo11ow-up.




The incident of non healing ulcers had commonest site was as below knee out of 1076 non healing ulcers 778 were present on the leg, & foot which jncluded varicose diabetic, traumatic and tropical ulcers. The varjcose ulcers were commonly present on the lower one third of medical aspect of the 1eg and the calf which was surrounded by bluish black dark pigmentation. These ulcers were firmly adherent to the deeper soft tissue and bones. Ulcers were healed by use of jaggery without any treatment for the varicose venis. But they have tendency to recur. Traumatic ulcers which were situated on lateral one third of the lower leg turned into non healing ulcers commonly. Usually traumatic ulcer used to heal from periphery of the wound and an island of dry pale ulcer use to remain non healing in the centre surrounded by thick hypertrophic scar with fibrotic base. In these central of recalcitrant non healing ulcers, healing was restimulated by jaggery dressing.



Diabetic foot is a combined effect of sepsis, ischemic, neuropathy and hyperglycemia. D1abetic ulcers were commonly present on foot though other sites were not exempted. These wounds were healing slowly after the control of hyperglycemia. Jaggery contains sucrose and glucose but it was proved to be useful 'in the treatment of 212 cases of diabetic ulcers. Infective edema & dusky ischemic colored skin around normalized and wound started healing due to application to jaggery dressing. In 212 cases of diabetic ulcers all cases improved, 18 cases died due systemic cause related to complications of diabetics 11 cases had partial healing and they were lost to fo11ow-up. In 183 cases complete healing of wound was achieved which included diabetic tropic ulcers too.



Burn injuries heal rather differently than other mechanical ones. Burns injuries always take a longtime for healing and have susceptibility to infection and formation excessive scar tissue. Non healing ulcers were formed by granulation tissue surrounded by the scar tissue. In the beginning these burns wound started healing normally but after healing certain area healing process went arrested due to unknown reason. In 102 non healing ulcers skin grafts were done without success. In 56 cases second type of the non healing wounds were covered by thick black eschar. In the both type of the cases jaggery dressing was useful. In the first type it controlled hyper granulation and stimulated espithelisation. In the second type jaggery was a useful agent in debridement of the eschar tissue. Use of jaggery is a fine art to debride eschar tissue. 1|tt 158 cases healed we11; hypertrophic ulcers were noted in 152 cases.



BED Sores-


Bed sores are result of pressure necrosis. They were presented as hard dry patch of hide on the body over the pressure points. Separation of dry eschar required a longer time in the beginning but once it was started loosening, it was easily removed. In this series L9B cases of the bed sores were measuring Flat bed sores 12 square centimeters to 252 square centimeters & deep bed sores from 10 C.C. to 240 C.C. In these nonhealing bedsores air cushions or water beds were essential to avoid further pressure necrosis and more damage.




They were smallest ulcers in size situated on the pressure points of the foot took longer time to heal than routine search in required to locate the pressure points due to misfiting foot ware which were protected by extra pads and soft sponges. Invariably rest gave better result but the ulcers had tendency to recur even after complete healing. In certain cases special protection was offered to the affected part by sing special shoes and splints. Out of 92 tropic ulcers 18% cases had partial response, B2/cases healed well.




Radiation therapy particularly through its long term effect creates obstacle to repair of wounds. As little as 250 R. will retard neovascularisation and contraction of the open wound. As time passes radiated tissue loses its blood flow. Intimal proliferation slowly closes blood and lymph vessels and ischemic tissue heals poorly and also susceptible to infection. Two types of the radiation wounds were included 'in this study. In the first group of 76 cases of post radiation operated were presented with necrosis of the skin flaps and deeper soft tissue. Second group included 7 cases of open wounds due to radiation injuries directly. The post radiated head & neck Srifgieil- cases used to pose a problem of potential danger of the skin flap necrosis resulting a wide open wound exposing vital carotid arteries endangering them with impending blow. Jaggery had derided these wounds faster and protected the carotid arteries from sloughing. The open ulcer in the tissue severely damaged by radiation is a difficu1t challenge. The debridement of the superficial tissue in these ulcers followed more surface necrosis and more debridement was necessary even the tissue failed to bleed when it was cut. Jaggery was very useful in the continuous debridement process too. In 83 cases of radiation wounds 1.2 cases expired due to systemic diseases and 6 cases had partial response. In 857 of these case healing was achieved.




The present study is the first Clinical Assessment carried out the utility of jaggery in the treatment of chronic non healing wounds. It is used as a home remedy in the Western part of Maharashtra State of India. Physical, biological and chemical properties of jaggery have been observed and documented in relation to the treatment of nonhealing wound. Almost all over India the cane jaggery is used commonly known as 'Gur'. Contents of Jaggery (3 & 4) are Moisture 3.9 percent, Proteins 0.4 percent, Fat 0.1 percent, Carbohydrate Sucrose 95 percent, Mineral s 0.6 percent, Calcium 80 mg.%, in 100 grams of Jaggery. Phosphorous 40 mg.per 100 grams of Jaggery Ferrous 11.4 mg.per 100 grams of jaggery. Carotene (V'ita) 280 I.U.per 100 grams of jaggery. Thiamene 0.02 per 100 grams of jaggery. Ni coti ni c ac'id 1 .0 mg. per 100 grams of jaggery. Zine 5-7 mg.per 100 grams of jaggery. - Managanese 2-4 ng.per i00 grams of jaggery. The good quality of jaggery has low percentage of glucose and high percentage of sucrose. Ideal dressing has a great value and wide application in treatment of all wounds particularly significant in the nonhealing wounds. First 1 year of such dressing is usually prepared of fine mesh gauze so that healing granulation tissue would not penetrating the interstices and cause bleeding when the dressing is removed. A long search for a topical substance to incorporate in the gauze which would stimulate wound healing, has been not successful so far. The choice is given to use bland substance like petroleum jelly or topical antibiotics’ in water soluble base impregnate gauze.The  value of such dressing is less adhesive to the granulating neovascular and epithelial tissue and has least interference in healing of the wound. Jaggery dressings are not adherent to the wound and can be easily removed without causing any hemorrhage and destruction to the growing epithelium and neovascIar tissue. Application of jaggery dressing has acted as an excellent deodorant extinguishing foul smell Liberated by the organisms Iike pseudomonas, E Col j facalis, 0ther organisms and the necrotic tissue in about one to two weeks. The slough adherent to the wound was derided by the complex enzyme and chemical action activated between the necrotic organic material and jaggery. The traces of vitamin like thiamine, pyridoxine, and nicotinic acid promote enzyme reaction like oxidation, reduction, decarboxylation of keto acids and amino group transferase from jiggery wh1ch assist in the process of de sloughing. In the cases of bed sore, radiation necrosis and eschar slough got separated in 2 to 4 days and the slough separation was completed’ in 2 weeks. The speed of the debridement was varied’ in the different cases but it was faster than any material used in the present days. As soon separated slough was removed completely, the debridement action was stopped. It has detergent action on wound which clears staining of wound & wound dressing by the micro organism in the first week of application of jaggery dressing. Hygroscopic action due to high concentration of sucrose 85% and glucose 8- 1O% in the jaggery dressings enforced absorption of fluid from the surrounding area of wound. The irregular surface and the wide area of wound reduces’ in size, and then the surface turns regular which improves the vascularity and oxygenation. Jaggery absorbs wounds fluids into the dressing and the dressing of the wound is kept wet by the wound fluids. Normally wound fluids contain substantial amount of the growth factors which assist in stimulating neovascularization, collagen deposition and epithefizatjon. The quality and the quantity of the wound fluids changes over the time as the wound heal. The wound fluids derived from the acute Jaggery contains 280 I.U. of carotene-Vita-per 100 grams which assists to re stimulate the suppressed reparative process of wound healing. How it is done is not clear but it is thought to be the reverse of the stabilizing effect of the suppressed inflammatory reaction on the lysozymal and the cell membrane. Vita A is an excellent immune adjuvant. topical application of vita A assists wound healing (13). Jaggery contributes 5-7 milligrams of Zinc per 100 grams which is essential factors to mobilize vita A from the liver. Steroids depress Zinc level. Zinc has been an useful element 'in the treatment of nonhealing wound. Usually the "zinc level is below 100 mg. percent if zinc deficiency is the causative factor for  nonhealing of the wound. In the zin c deficiency most surgical wounds heal under slightly abnormal influx of polymorphonuclear leukocytes and microphages which cause more necrosis and more debridement is required. In addition, the activity of several enzymes is essential for the cell reproduction such as DNA Polymerase and reverse transcriptase which are zn  Metalloenzymes. Zinc might control the rate of wound healing & fibrosis by limiting the inflammatory cell reaction 0r proliferation (i4,15). Topical application of Zinc Oxide Unna's paste is useful in wound healing. 11-15 mg. of iron is present per 100 grams of Jaggery which is essential for hydroxylation of lysine and pralines in the formation of Collagens (15). Iron increases the activity of myeloperoxidase an iron dependent enzyme which assists intracellular bactericidal activity. From 100 grams of jaggery Z-4 mg. of manganese is estimated which functions as an activator of enzymes such as phosphatase, decarboxylase, kinase, glycossyl transferase and arginase. The manganese deficiency would effect the formation of connective tissue and thus interferes in the wound healing. It appears that the chemical & physical properties of jaggery and the complex enzyme reaction with the wound and necrotic material assist in the treatment of nonspecific nonheaiing wounds. Estimated cost does not exceed more than rupee fifty per patient as far as material is concerned. No untoward effects were noted. Thus the treatment is worth for nonhealing wound at a worthless price. Wound stimulates wound healing (6). The study conducted by Bucolo and colleagues demonstrated that the wound fluid from the chronic wound inhibit the proliferation of micro vascular endothelial cells. (7) The chronic nonhealing wound secrete impaired wound fluids. The cause for inadequate production, of impaired wound fluids and growth factors is uncertain, which may be the result of one of the cause or combined effect of ischemia, presence of toxic factor or the fibrosis at the base and periphery of the wound obstructing diffusion of the wound fluid .into the wound. Jaggery absorbs the wound fluids from the wound due to effective extra 0smotic force by overcoming the Obstruction in membrane (wound Base) & defects caused by fibrosis in and around the wound. The Osmotic force is constantly maintained by changing the dressing. Number of articles have  reported the ability of the growth factors from the wound fluids to enhance the wound repair (6, 8, 9). The diffusion of the wound fluids through the base and the margins of the wound bring inflammatory cells into the wound. Once phagocytes arrive in the wound they recognize their natural prey, The phagocyte activity requires energy and exhibit increased oxygen consumption so much as 20 times greater than basal level (10,11). As tissue edema decreases it improves tissue turger and oxygenation. The delivery of nutritional substances for energy at healing edge is extremely deficient, and more deficient at the centre of nonhealing wound. The margins of nonhealing wounds- are hypertrophic and the centre of it is very thin & pale dry thin granulated. It iS possible that cells in the close vicinity of the peripheral capillaries consume glucose so extensively and rapidly that the supply to most of the peripheral cells is limited (12). jaggery provides local hyper alimentation which contains sucrose 85% and glucose 8-10% and some traces of minerals, vitamins and amino acids. The hygroscopic property and osmotic force of iaggery dehydrates micro organisms and the infection is cleared efficiently. Jaggery has bactericidal activity well demonstrated in vivo than in vitro. The jaggery has shown no sensitivity zones on bacterial culture in 130 cases (Table No.5).





. l. Need for chair of Tropical Surgery C.Ho.l ecombe, Br.J.Surg,l990,77:3_3_4.

' 2. 0rganisation and- development. of an University multidisciplinary wound care clinic, Steel DL, Edingtion H, Moosa HH, t,lebster il.H.Surgery 1993; 114 :775_719.


3. The rrlear th of India, Raw l,|aterials vor IX pubrication and Information directroate C.S.I.R. New. Delhi 1973.

4. Nutri ti ve var ue of Indi an food, Gopar an G. Ramshastri 8.v,, Bar subramai an s.c. National Institute of nutrition I.c.M.R. Hydrabad India l9S9reprint 1993.

5' Mark J'A' Aguide to the vitamins, Their role in heal *r a'na d.i sease. Lancaster Engl and. Techni cal publ i shi ng Company 1975.

6' Enhanqement of wound healing by topicar treatment with epidermai growth factor. Brown G. L,Nanny L,B.Griffen J, Creamer AB, yancey SM, Urtsinger LJ III, Ho,l tzin L, Jurkiewicz iliS, Lynch JB, N.Engl.Med.1989, 321._76_76.

7 ' Inhibition of ce, proliferation by Bhronic r,round F.r uid. Burcolo B, Eagistein l,lH, Schultz G.S.,t,lound Rep.Reg.l993, 1:181_186.

8' Epidermal growth factor receptor distribution in burn wounds. Implication of growth factor mediated repair. ,,enzac BA, Lynch JB, Nanney LB, it.Clin. Inv.1992,90 Z3gZ_Z4Ol

9' Effect of epidermal growth factor on celi proliferation in normal . and wounded connective tissue, Marcherek p, schurtz r,ri ngren u, Franzen L, !'lounql Rep.Reg.1993, t:63_6g.

10' 0xigen dependent microbial ki,ing by phagocytes, Babior BM (First of two parts). New Eng1.J.liled.l978; 298-659.

11' 0xigen and wound healing, niikikoski rl . ctin. prast. surg. 1,g77;4:361,.*-*-"TZ.*-toaaT hyperaliinentatioh of 'ripeir wounds, vijanto J, Raekailio J,

Br.,J,Surg,l976, 63 :427,


13' Fundamentars of wound hearing, Ed. by Hunt. T.K.Dumphy irE, Appleton century crafts. New york 1979.

14' conspectus of research on Zinc requirement of ,nan, Harsted J.A., Smith J.C., Irwin MI, J.Nutr.l974, 104:345.

15' Newi:r 'aspects of the role of zinc, managanese and copper in human nutritjon.-,Burch R.E.,Hahn HKJ, Sullivan IF, Clin.Chem 1975:21:501.



Table No. 1 Types of wounds treated by joggery

Bed sores                                                  198

Traumatic wounds                                       019

Trophic Ulcers                                             092

Diabetic wounds                                          212

Burns  Wounds                                            158

Radiation wounds                                         083

Varicose Ulcers                                             314

Total                                                         1076




Table No. 2 Swab & Tissue culture

Pseudomonous Pyosynae                               28

Escheresia Coli                                               38

Staphilococcus auriolous                                  18

Mixed Coliformis                                              12

Klebshiella                                                       07

Strepococci faecalis                                          13

Sterptococci Pyogenus                                      10

Staphilococci Coagulase                                      2

Pseudomonous Aerogenosa                                2






Si ze of Ul cer        Area of FI at Ulcer In Square Centimeter   No. Of cases

1- 50                                                                                                436

51 – 100                                                                                           315

101 -150                                                                                           204

151 -200                                                                                           053

200 onwards                                                                                      051

Total                                                                                                1013



Table No. 4 Duration of non healing

Duration in months                                         No. of Cases

3-6                                                                       532

6-9                                                                       266

9-12                                                                     106

12-18                                                                    62

18-24                                                                    48

24-30                                                                    10

30-on wards                                                          51