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

Robert H. Demling, MD

Disclosures

ePlasty. 2009;9:65-94. 

In This Article

The "Stress Response" to Wounding

The host response to severe illness or infection is an amplification of the fright-flight reaction.[11,12,38–40] The insult leads to the release of inflammatory mediators that activate a very abnormal (Table 5) hormonal response, led by a marked increase in catecholamines and other hormones that produce a hypermetabolic-catabolic state.[38–41]

An entire spectrum of abnormalities can be seen after injury and inflammation due to degrees of the manifestation of the host "stress response" to a body wound. If uncontrolled, the stress response can progress with loss of body protein and impaired wound healing. The once protective response then becomes autodestructive, and intense autocannibalism (catabolism for fuel) occurs with rapid loss of LBM[38–41] (Fig 10).

Figure 10.

There is an overall increase in energy demands. Glucose production by the liver is markedly increased because of a hormonally driven process by amino acids from reabsorbed lean body mass. There is a net catabolic state. Energy demands are not selectively obtained from the fat deposit. Excess energy production is converted into excess body heat released through the skin. There is no protection of lean mass during this process.

Controlling the degree of ongoing injury requires both controlling the host response and at the same time supporting the metabolic needs to avoid further deterioration. However, catabolism still outweighs anabolism as the catabolic hormones predominate and the anabolic hormones, growth hormone, and testosterone are still decreased. Massive protein depletion can occur in days to weeks after a severe injury with wounds until the wound has been closed and the stress response has been removed.[14,38–44]

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