How are malnutrition and vitamin deficiencies addressed during the dermatologic preoperative evaluation and management?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

Deficiencies of vitamins A, C, and K impair normal wound healing. Zinc deficiency affects protein synthesis and cell migration. Zinc deficiency can be treated with oral zinc at 222 mg. Vegetarian patients have also been reported to experience delays in wound healing.

Malnutrition leads to a significant increase in the operative death rate. Weight loss of more than 20% caused by illness (eg, cancer, intestinal disease) results in a higher death rate and a greater than 3-fold increase in the postoperative infection rate. Obtaining a dietary history is of major importance in the preoperative evaluation, as is a working knowledge of the basic nutritional deficiencies associated with certain disease states, particularly vitamin deficiencies. Standard biochemical parameters that indicate impairment in the visceral protein mass include a serum albumin level of less than 3 g/dL or a serum transferrin level of less than 150 mg/dL.

When malnutrition is diagnosed, no consensus has been reached regarding the indications of short-term (7-10 d) preoperative hyperalimentation. The appropriate nutritional state can improve wound healing and immune function. Current indications for supportive measures before elective surgery include a history of weight loss in excess of 10% of body weight or an anticipated prolonged postoperative recovery period during which the patient will not be fed orally. Patients who have had a gastric bypass or lap band procedure have surgically induced malabsorption syndromes. Vitamin supplements and protein shakes preoperatively improve healing.


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