Nutrition, Anabolism, and the Wound Healing Process: An Overview

Robert H. Demling, MD

Disclosures

ePlasty. 2009;9:65-94. 

In This Article

Conclusion

Nutritional status is extremely important in wound healing, especially the major wounds. A common nutritional deficiency state is PEM, either that produced by the "stress" response to wounding or a preexisting state.[155–169]

Maintenance of anabolism and controlling catabolism is critical to optimizing the healing process. Increased protein intake is required to keep up with catabolic losses and allow wound healing anabolic activity. Micronutrients, carbohydrates, and fat are used predominately as fuel, but each has direct wound effects essential for healing. Protein as a micronutrient is inappropriately used for fuel after injury, so intake needs to be increased to allow for protein synthesis. There are also specific actions of protein by-products impeding the healing process.

Micronutrients are often ignored, but, as described, there are many essential metabolic pathways depending on the vitamins and minerals. Select amino acids such as glutamine are also essential. Of importance is the fact that increased losses of many micronutrients occur in the presence of a wound. In addition, increased daily requirements are needed to keep up with an increase in demands during the postinjury hypermetabolic state. Also, supplementation of compounds such as glutamine has not only been shown to improve wound and immune states but also to decrease trauma- and burn-induced mortality.

Finally, controlling catabolism by producing anabolism by agents, many being endogenous, has been shown in the presence of adequate protein intake to increase net body anabolism, which, in turn, will improve overall protein synthesis including the wound.

Anabolic hormones are necessary to maintain the increased protein synthesis required for maintaining LBM, including wound healing, in conjunction with the presence of adequate protein intake. However, endogenous levels of these hormones are decreased in acute and chronic illness and with increasing age, especially in the presence of a large wound. Because the lost LBM caused by the stress response, aging, and malnutrition retards wound healing, the ideal use of these agents is to more effectively restore anabolic activity. There are also data that indicate a direct wound healing stimulating effect for some of these hormones.

Recognition of all these principles will optimize the wound healing effects of nutritional support.

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