Nutritional Categories & Wound Healing

As we mentioned last week, a number of key nutritional categories that are essential for both the prevention and management of chronic wounds. This week we will briefly review the major categories of nutrients, and describe their importance in wound care.^1–4

Essential Nutritional Categories

• Water – Water is one of the most essential nutritional categories to wound healing.  A fluid environment is necessary for all cell functions. Even in the absence of other nutritional deficits, dehydration will still result in impaired wound healing. In general, healthy individuals with open wounds need 30–35 mL of water per kilogram of body weight daily, while patients with large wounds or burns may need even more.  Patients on air-fluidized beds for severe pressure ulcers may require up to 40–60 mL of water per kilogram of body weight every day.
• Protein – Adequate protein stores are required for effective collagen synthesis, granulation tissue formation, angiogenesis, and remodeling. Proteins also protect immune functions and osmotic pressure.  Because patients may lose significant protein through wound drainage, it is particularly important that patients with chronic wounds receive adequate protein intake.
• Carbohydrates – Carbohydrates, which are primarily consumed in the form of glucose, provide energy for tissue repair and regeneration. They also offer a protein sparing effect which reduces the burden for protein intake.
• Fats – Although fat is often thought of as undesirable in the context of healthcare, a limited supply of fats is needed for effective wound care. Fats solubilize essential vitamins and provide a needed energy source when carbohydrates have been depleted. In the form of free fatty acids, fats are also essential components of cell membranes and are required in the synthesis of new cells.
• Vitamins – Vitamins are essential to build new tissue, to maintain tissue health, and to aid in normal immune function. In terms of wound care, Vitamin A (retinol), Vitamin C (ascorbic acid), Vitamin K, Vitamin B complex, and Vitamin E are particularly important. Each of these makes up a greater whole for this nutritional categories. 
• Minerals – Trace minerals are important for the wound healing process, and include both microminerals (zinc, iron, copper, and magnesium) and macrominerals (calcium and phosphorous).

Deficiency in any of these areas of nutrition can lead to impaired wound healing. Next week we will consider how nutritional status should be assessed, and in the final week on this subject, we will look at strategies for improving nutritional status in patients.

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References

1. Stotts NA. Nutritional assessment and support. In: Bryant RA and Nix DP. Acute and chronic wounds. Current management concepts. 3^rd ed. St Louis, Missouri; Mosby Elsevier; 2007.
2. Posthauer ME, Thomas DR. Nutrition and wound care. In: Baranoski S, Ayello EA, eds. Wound Care Essentials: Practice Principles. 2^nd Edition. Lippincott Williams & Wilkins, Ambler PA. 2008.
3. Myers BA. Wound management principles and practice. 2nd ed. Upper Saddle River, NJ: Pearson; 2008.
4. Posthauer ME. Nutritional assessment and treatment. In: Sussman C and Bates-Jensen B. Wound Care: A Collaborative Practice Manual for Health Professionals. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.