Surgical wound healing can be accelerated and influenced by nutritional, biological, botanical factors and mechanical approaches.
If you’re planning to have cancer surgery in the near future or recently had surgery, your thoughts undoubtedly move to how you can minimize the trauma and scarring associated with treatment and speed the healing process. Healing wounds whether from accidental injury or surgical intervention requires a delicate interplay of multiple cell types, nutritional factors, immune processes and growth factors. Proper planning and prompt attention can promote normalization in appearance.
Healing - From the Inside Out
Wound healing is a stepwise process involving hemostasis, inflammation, and remodeling. During hemostasis, blood platelets release clotting factors and growth factors to help the body create a protective wound scab. This barrier provides a surface beneath which cell movement can occur. Then the process of inflammation brings nutrients to the area, removes debris and bacteria, and provides chemical signals for wound repair. Healing proceeds only after inflammation is controlled. The repair process can then begin to build new skin, fibrous tissue and blood vessels.
Deficiencies of proteins, vitamins, minerals and fluids may significantly impair the healing process. Vitamin C (ascorbic acid) found in citrus fruits, tomatoes and green peppers is required for the formation of the connective tissue protein collagen. The precursor to Vitamin A (retinol) is found in carrots, cantaloupe, tomatoes, eggs, butter and cheese. It is essential for cell growth, skin and bone formation and immunity. The body uses glucosamine to build connective tissue. Adequate dietary protein is necessary to build new tissue. Surgical trauma produces a sharp decrease in serum zinc concentration. Zinc is an important cofactor for enzymes that control the collagen matrix. It has demonstrated anti-infective action, inhibits formation of reactive oxygen species and promotes skin formation.
Healing - From the Outside In
Topical vitamin E and ascorbic acid, calcium D-pantothenate and fibronectin can speed wound healing. Other novel approaches involve topical application of a mixture of various growth factors (PDGF, TGF-beta, PDAF, PF4, PDEGF) to slow-healing wounds. Skin graft donor site healing time has been reduced by one day using topically applied epidermal growth factor (EGF). Zinc oxide in paste bandages (Unna boot) protects and soothes inflamed skin. Topical administration of zinc appears to be superior to oral therapy due to its action in reducing superinfections and enhancing local defense systems.
Pressure is thought to decrease tissue metabolism and increase collagen breakdown within the wound. Silicon gel sheets (applied for 12 hours/day) add pressure and are also thought to work by hydrating the scar tissue. Rehydration softens the scar, thereby making it more flexible and improving the natural repair and flattening process. The newer the scar, the better the result. Onion extract (Mederma) has been shown to improve hypertrophic and keloids scars. However, it was ineffective in improving scar height and itching. For this reason, onion extract therapy should be used in combination with a silicon dressing to achieve a desirable decrease in scar height. Aquaphor is a petroleum based product that has been shown to speed healing of damaged skin.
In summary, each phase of tissue repair can be influenced by nutritional, biological, botanical factors and mechanical approaches.
| Stage | Nutritional/ Botanical Factors | Physical/Mechanical Factors |
| Hemostasis* | Topical zinc paste ( anti-microbial) | Topical hyaluronic acid Aloe Vera Aquaphor Silicone Sheets |
| Inflammation | Omega-3 fatty acids Protein Vitamins C/A Glucosamine Bromelain |
|
| Proliferation | Vitamin C Glucosamine Zinc Centella asiatia (collagen formation) |
|
| Remodeling | Protein i.e. arginine enhanced diet, hydrolyzed collagen supplement |
|
| *Avoid factors that inhibit blood clotting prior to surgery |
||
Cancer is a significant factor in slowing wound repair. Processes intrinsic to cancer, such as hormonal disregulation, chronic inflammation, nutritional deficits, etc. work against the repair process. However, addressing these clinical issues and integrating the above approaches can improve the wound repair process.
References
Brown, SA. Plast Reconstr Surg. 2004 Jul;114(1):237-44 Oral nutritional supplementation accelerates skin wound healing: a randomized, placebo-controlled, double-arm, crossover study.
Chithra, P. Mol Cell Biochem. 1998 Apr;181(1-2):71-6. Influence of Aloe vera on collagen characteristics in healing dermal wounds in rats.
Chung, V. Dermatol Surg. 2006 Feb;32(2):193-7 Onion extract gel versus petrolatum emollient on new surgical scars: prospective double-blinded study.
Diegelmann, R. Front Biosci. 2004 Jan 1;9:283-9. Wound healing: an overview of acute, fibrotic and delayed healing.
Hosnuter, M. J. Wound Care. 2007 Jun;16(6):251-4. The effects of onion extract on hypertrophic and keloid scars.
Komarcevic , A. Med Pregl. 2000 Jul-Aug;53(7-8):363-8. The modern approach to wound treatment.
Lansdown, A. Wound Repair Regen. 2007 Jan-Feb;15(1):2-16. Zinc in wound healing: theoretical, experimental, and clinical aspects.
MacKay, D. Altern Med Rev. 2003 Nov;8(4):359-77 Nutritional support for wound healing.
Mandal, A. J Wound Care. 2006 Jun;15(6):254-7. Do malnutrition and nutritional supplementation have an effect on the wound healing process?
McCarty, M. Med Hypotheses. 1996 Oct;47(4):273-5. Glucosamine for wound healing.
Russell, L. Br J Nurs. 2001 Mar;10(6 Suppl):S42, S44-9. The importance of patients' nutritional status in wound healing.
Phillips, S. ASAIO J. 2000 Nov-Dec;46(6):S2-5. Physiology of wound healing and surgical wound care.
Wound Care Links
http://www.southwestmedical.com/Woundcare_Products/Specialty_Woundcare/CollagenSilicone/574c0
September 2007
Last updated February 2011
