Oral Arginine Supplementation and the Effect on Skin Graft Donor Sites: A Randomized Clinical Pilot Study

Abstract

Although arginine has been shown to improve healing in rodents and in small induced wounds in healthy volunteers, little is known about the effects of arginine supplementation on healing of clinically relevant surgical wounds. We studied 18 patients in a double-blind randomized pilot study (12 men, 6 women), who underwent skin transplantation as part of reconstructive surgery. Patients were randomly assigned to receive arginine (n = 8) or placebo (n = 10) supplementation as an enteral dose of 36.2 g of l-arginine-HCl or an isocaloric amount of placebo (51.2 g alanine), respectively. Wound healing was evaluated at the donor sites of skin grafts by measuring angiogenesis, reepithelialization, and neutrophil count. Arginine metabolism was studied by measuring plasma and wound fluid amino acid concentrations. Our results show that none of these parameters were significantly different between the oral arginine supplementation group and the placebo group. In conclusion, enteral arginine supplementation does not improve wound healing of skin donor sites.

Effects of intravenous arginine on the healing of human skin graft donor sites: A randomized controlled trial

“…Through CGMP, NO decreased platelet aggregation rate, inhibited the formation of thrombus, reduced resistance of blood flow and improved microcirculation of the flap (Ozyazgan et al, 2007;Debats et al, 2009;Debats et al, 2011;Afraz et al, 2012). Secondly, to inhibit the injury of leukocyte mediated: foreign scholars found in the study of skin graft that after lifting the flaps, inflammatory cells increased including leukocyte and mastocyte, which mainly increased white blood cells.…”

Nutrition and Chronic Wounds

“…77 In a randomized controlled trial, Debats et al did not find improved healing with skin graft donor sites in patients who received intravenous supplementation with arginine. 78 However, this study may be misleading due to the fact the arginine was given intravenously and trying to measure differences in skin graft donor sites might be difficult since such wounds normally heal quite well. Stechmiller and Schols review some of the recent studies in more detail.…”

Micronutrients, Arginine, and Glutamine: Does Supplementation Provide an Efficient Tool for Prevention and Treatment of Different Kinds of Wounds?

“…Arginine supplementation did not affect wound healing in patients undergoing autografting as a part of reconstructive surgery, 32,33 but lowered the risk for fistulas in patients with oral and laryngeal cancer undergoing elective surgery. [34][35][36][37] The different effect on wound healing may be explained not only by the choice of parameters, but also by the health status of the participants, which was probably much worse in cancer patients than in patients with reconstructive surgery.…”

“…However, parameters of wound healing (neutrophil index, angiogenesis, and re-epithelialization) were not different from the placebo group that received isocaloric amounts of alanine. 32 If arginine (30 g/day) was given intravenously in addition to the hospital diet, differences in wound healing (neutrophil index, angiogenesis, and percentage of re-epithelization) between verum and control (arginine) did not occur either. 33 In several RCT of de Luis et al, 34 arginine-enriched enteral …”