Wound Healing and Nutrition: Going Beyond Dressings With a Balanced Care Plan

Abstract

As the largest organ of the body, the human skin protects all subcutaneous tissues. Despite its many attributes, the skin is vulnerable to pressure ulcers. The number of pressure ulcers and venous leg ulcers is on the rise, but healing rates have not improved over the past decade. The reason may be a tendency to focus on one or two fundamentals of wound healing, but not on all 3 fundamentals equally. The 3 fundamentals of wound healing are (1) pressure relief and nursing care, (2) dressings, and (3) nutrition. Nutrition is the area that is most often overlooked, which commonly causes the care plan to be out of balance. In the United States, few clinicians would consider malnutrition to be an issue in the homecare and long-term care setting, yet nutritional status and risk for pressure ulcer formation are well documented and strongly correlated. Our aging population will continue to survive previously catastrophic events, only to present with pressure ulcers or the potential for developing pressure ulcers. Clinicians caring for residents with pressure ulcers must strike a balance between pressure relief, dressings, and nutrition. Functional gastrointestinal-tract impairments must be diagnosed and addressed. Wounds must be treated aggressively with high-protein calorically-balanced diets because wounds heal from the inside out.

Measuring discomfort—An objective method for quantifying peak pressure discomfort and improved fit in adults with transtibial amputation

“…We cannot state that pressure reduction of this magnitude will resolve all issues and factors such as vascularization 49 . Comorbidities such as diabetes and arterial and venous insufficiencies, 50 pressure, dressings, and nutrition 51 should be considered. Variations in the extent and localization of perfusion, infection, patient characteristics, and treatment strategies such as offloading, reduced use, or additional gait aids may also be responsible 52 .…”

Early Results of Supporting Free Flap Coverage of Mangled Lower Extremities with Long Saphenous Arteriovenous Loop Grafts.

“…40e42 Diets with high-protein and calorically balanced are well known to maximize wound healing from the inside out. 43 During our pretreatment of patients and throughout their rehabilitation process, prealbumin levels and nutritional evaluations were routinely conducted throughout the healing process. When necessary, protein and vitamin supplements were given to patients and laboratories redrawn to ensure nutritional support.…”

Nutrition and the Plastic Surgeon: Possible Interventions and Practice Considerations

“…For example, protein depletion leads to a prolonged inflammatory phase by decreasing fibroblast proliferation, proteoglycan synthesis and neoangiogenesis. 9 Not only does wound healing require adequate nutritional input, but wounds increase baseline caloric and protein demands. 9 Micronutrients also play significant roles in the process of wound healing.…”

“… 9 Not only does wound healing require adequate nutritional input, but wounds increase baseline caloric and protein demands. 9 Micronutrients also play significant roles in the process of wound healing. Vitamin A stimulates fibroblasts, 10 vitamin C promotes collagen synthesis and fibroblast proliferation, 11 and zinc is essential for protein and collagen synthesis.…”