In addition to carbohydrates, proteins and fats (macronutrients), there are a number of micronutrients that are necessary for wound healing.
Vitamin A (retinol) is a fat-soluble vitamin that helps to maintain tissue integrity and healthy skin. This important vitamin is required for the formulation of granulation tissue, synthesis of collagen, epithelialization and macrophage functioning. Research suggests that vitamin A may enhance wound healing that has been complicated by diabetes, stress and radiation. This vitamin may be particularly important for patients who must take steroids, which can affect wound contraction and collagen synthesis.
Vitamin E is another fat-soluble vitamin. A potent antioxidant, vitamin E helps prevent damage at the cellular level caused by free radicals. Vitamin E also decreases the inflammatory phase of wound healing and enhances immune function, in addition to decreasing platelet adhesion.
B complex vitamins are a group of 8 vitamins that are water soluble. B complex vitamins are necessary for energy metabolism and normal functioning of the immune system. Specifically, they help with white blood cell functioning, resistance to infection and formation of antibodies. They also help to improve the tensile strength of wounds.
Vitamin K, a fat-soluble vitamin, is essential to normal blood clotting. A deficiency in vitamin K may lead to a prolonged inflammatory phase and wounds that bleed easily.
Vitamin C (ascorbic acid) is needed to build tissues, as well as to maintain them. Vitamin C is necessary for the body to absorb iron. It is also necessary for the synthesis of collagen. Deficiency of this important vitamin may result in delayed wound healing, decreased wound tensile strength, and an increased risk of wound dehiscence.
Calcium is necessary for blood clotting due to its role in fibrin synthesis, although we often think of calcium in relationship to bone formation and muscle contraction.
Magnesium is necessary for control of blood pressure and blood vessel contraction; magnesium deficiency is associated with dehydration, diabetes and alcoholism, conditions which can deleteriously affect wound healing.
Zinc is an antioxidant that is believed to enhance wound healing by reducing free radicals. It is vital to protein and collagen synthesis, epithelialization, immune function and cellular proliferation. Research is inconclusive in regards to its necessity to wound healing, but animal studies show that supplementation with zinc enhances wound healing in animals that are deficient in zinc.
Copper helps to enhance collagen cross-link strength, thus it is important in enhancing wound tensile strength. Copper is also necessary for proper immune functioning, hemoglobin synthesis, and iron absorption and transport.
Iron is required for oxygen transport, antibody production and and normal immune function. It is an important cofactor in many enzyme systems and is necessary for DNA and collagen synthesis. Deficiency in iron may lead to tissue hypoxia, decreased replication of cells, decreased wound tensile strength and decreased immune function.
Phosphorus is an important cofactor in many enzyme systems, in addition to being necessary for normal metabolism.
As can be seen, micronutrients play an important role in wound healing, as do the macronutrients (fats, carbohydrates and proteins). Deficiency in any of these may negatively affect wound healing. In our next segment, we’ll discuss nutritional screening of patients with acute and chronic wounds.
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Meyers, B (2008). Wound Management: Principles and Practice. 2nd edition. Pearson Prentice Hall. Upper Saddle River, New Jersey. pg. 198-199.
Nutritional Support. Wound Source. http://www.woundsource.com/patientcondition/nutritional-support