Trauma and Wound Healing
Dietary and Lifestyle Management
Proper nutrition is a very important factor in all phases of the wound healing process. During the recovery period, suboptimal nutrition can affect collagen synthesis, strength of wound tissue, and the body's ability to fight off infection (Quain 2015).
Wound healing is a metabolically demanding process that requires sufficient energy, in the form of calories, to proceed (Molnar 2014). Additionally, the reconstruction of injured tissue depends on the presence of protein as well as metabolic precursors and cofactors, including some vitamins, that sustain cell growth and division and new tissue synthesis (Molnar 2014; Posthauer 2007). Important nutritional factors for wound healing include:
- Eating sufficient calories from a well-balanced diet
- Consuming optimum amounts of protein
- For diabetic patients, controlling blood sugar levels
- Staying well hydrated
Total Energy (Calories)
Caloric needs during wound healing are estimated to be 30–35 kcal/kg of body weight, or up to 40 kcal/kg for an underweight patient. Distribution of calories should be similar to a traditional diet, with 45‒60% of calories from carbohydrate, 25‒30% from fat, and 15‒20% from protein, although more protein may be needed to support increased amino acid demands. Chronic wounds can increase caloric requirements by up to 50% and protein needs up to 250% in order to prevent loss of muscle (Molnar 2014).
Carbohydrates and Fats
Carbohydrate consumption must be sufficient for energy production. Simple carbohydrates (sugar) should be low enough not to exacerbate hyperglycemia, which can occur in critically injured patients and can suppress healing and increase inflammation (Mecott 2010; Rowan 2015). Fat and carbohydrate consumption are especially critical to monitor in burn patients as they are in an immunosuppressed state, and excess fat consumption can accentuate immunosuppression (Rowan 2015); in these patients, fat intake should represent <20% of non-protein calories, and carbohydrate intake should be less than 7g/kg/day in adults (Abdullahi 2014).
Elevated protein demands during wound healing come from increased amino acid requirements for cell growth and tissue repair, protein loss in fluids seeping from the wound, and breakdown of amino acids by the liver for energy (Breslow 1993; Molnar 2014). Chronic wounds can increase protein requirements by up to 250%. Protein requirements for patients under metabolic stress or recovering from surgical procedures can range from 1.0 to 2.0 g/kg of body weight depending on the diagnosis (Molnar 2014); the Agency for Healthcare Research and Quality recommends protein intake of 1.25 to 1.5 g/kg of body weight per day for patients with healing wounds.
Preventing dehydration is a very important part of the wound healing process. Without proper hydration, wounds will not receive the oxygen and nutrients needed for healing. A lack of moisture at the wound's surface can halt cellular migration, decrease oxygenation of blood, and delay the wound healing process. The goal for fluid intake in wound patients is approximately 1mL/kcal/day. However, more fluid may be required for patients with significant drainage or less for patients with heart or kidney failure (Quain 2015).
It has been hypothesized that the anti-inflammatory effects of exercise may be beneficial for tissue repair, especially in those with chronic inflammatory conditions (Pence 2014). In a study of 28 healthy older adults who underwent experimental wounding by punch biopsy, those assigned to an exercise group had faster healing compared with those in a sedentary control group (average of 29.2 days vs. 38.9 days, respectively) (Emery 2005). Animal studies also showed that exercise can improve wound healing (Pence 2012; Keylock 2008). Based on this evidence and the positive impact of exercise on overall health, it appears that exercise at a level appropriate to the patient's physical condition can be recommended to improve healing outcomes.