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Surgery, Wound Healing & Nutrition

Written by 

Deborah Freudenmann 

Nutrition is one of the most critical factors that play a role in the recovery of patients following surgeries, especially those performed for the management of cancer. The process of wound healing after surgery and the faster recovery from cancer is dependent on the amount of vital nutrients that the body receives.

Here is a brief discussion about the different wound healing processes occurring in the body following surgery and the best nutrients that can promote faster healing.

The effect of malnutrition

Malnutrition has been found to produce a serious adverse impact on the wound healing processes, particularly before and after surgery in cancer patients. Factors such as the location, stage, and the type of tumor can also interfere with the availability of nutrients to the affected site.

For example; the proliferative and more advanced forms of cancer located in the digestive tract could affect the process of absorption of food thus hampering the body’s supply of nutrients severely.

Moreover, the treatment of cancer like chemotherapy can cause side effects like nausea, and cachexia that can reduce the patient’s appetite and food intake putting him at a risk of nutritional deficiencies.

Therefore it is important to emphasise the need to prevent nutritional deficiencies in order to promote wound healing in patients, especially before and after surgery.

Wound healing process

Wound healing involves 3 primary processes as explained below:

1. Inflammation

This is the first phase of wound healing in which the immune system is activated resulting in the higher production of neutrophils, monocytes, and macrophages. These processes begin within the first 24 hours after an injury and last for up to two weeks.
This stage is marked by signs like redness, swelling, and warmth at the site of a wound.

2. Proliferation

Fibroblasts are the primary cells that support the proliferative phase of wound healing. The stage of proliferation involves the replacement of a temporary fibrin matrix with a stronger matrix of proteoglycans, collagen fibers, and fibronectin that help to restore the original structure and functions of the affected tissue.
Angiogenesis, which is marked by the formation of new capillaries that replace the damaged vessels to restore blood circulation, is also a characteristic feature of this phase. Other significant events occurring in the phase of proliferation include epithelialization and the formation of granulation tissue.

3. Remodeling

Remodeling refers to the processes in which the granulation tissues mature to form a scar. The remodeling phase is also aimed at increasing the tensile strength of the damaged tissues.

Impediments to wound healing

Hypoxia

Lack of adequate supply of oxygen to the vital organs of the body may occur due to the damage and destruction of the lung tissue as a result of cancer or other diseases such as COPD (Chronic obstructive pulmonary disease) or emphysema.
People, staying in higher altitudes also have a higher risk of hypoxia due to which the wound healing processes are impacted.

Immunosuppression

Medications used for the treatment of cancer, especially chemotherapy drugs, and steroidal medications used for the treatment of allergies and autoimmune diseases can suppress the immune system.
As a result, the wound healing processes may fail to occur in an efficient manner. It can also increase the risk of infections at the surgical site. Patients who suffer from diseases that compromise the immune system functions such as HIV/AIDS are also likely to experience delayed wound healing.

Infections

Infections in the lungs, or air passages, and the suppression of the immune system due to chemotherapy drugs used for cancer treatment can prevent the wound healing processes from occurring efficiently.

Nutritional deficiency

The deficiency of nutrients needed for supporting the functions of the immune system and the wound healing processes like vitamin C, and proteins can be responsible for preventing efficient wound closure.

Metabolic disorders

Pre-existing metabolic disorders such as diabetes could interfere with the wound healing mechanisms due to which the risk of delayed wound healing or infections at the site of the surgery may increase.

Dietary suggestions

Malnourished patients have a greater susceptibility to infectious complications along with delayed wound healing, which, in combination with their diseased state, significantly increases post-operative morbidity and mortality.

  • Ensuring hydration, drinking at least 2-3 L of water per day (especially the days pre surgery). Hydration is important as dehydrated skin is less elastic, more susceptible to breakdown and more fragile. Dehydration also impairs the supply of oxygen and nutrients to the wound or affected area.
  • Maintain protein levels after surgery. Essential amino acids including arginine and sulphur-containing amino acids (taurine, methionine, cysteine), are required for optimal wound healing and collagen deposition.
  • Ensure that anaemia is addressed prior to surgery. Supplementation with iron, vitamin B12, and folate will help support red blood cell synthesis.
  • Support the immune system with anti-inflammatory healing foods.
  • Ensure proper digestion is maintained by supplementation with digestive enzymes (bromelain, trypsin and pancreatin).

Nutrients that support healing

Vitamin A

Vitamin A can support the phase of inflammation and thus, trigger the wound healing mechanisms. Vitamin A can also promote the differentiation of the epithelial tissues and enable faster closer of the wound.
Nutrients like Genistein can support the epithelialization phase further and thus, enable faster recovery of patients who have undergone surgery for the treatment of cancer. 

Vitamin C

Vitamin C could boost the functions of the immune system and reduce the risk of infections at the site of a wound.
It can also enhance the transformation of lymphocytes and the migration of neutrophils to the surgical site. Moreover, vitamin C and other nutrients like Arginine are also needed for the synthesis of collagen that forms a strong and healthy matrix of cells essential for restoring the structural integrity of the affected tissues.

Proteins

Increased protein intake is vital for supporting the regeneration of new cells in the affected tissue so that the gap created due to the wound is bridged in a shorter period.
Proteins, together with bromelain, can also prevent the phase of inflammation from prolonging thereby protecting the patient against the risk of chronic inflammation.

Glucosamine

Supplementing with glucosamine is recommended for patients who have been advised surgery for the removal of cancer mass. Glucosamine enhances the production of hyaluronic acid that can protect the tissues against free radicals and oxidative stress thus enabling patients to recover faster following surgery. 

Zinc

The topical application of zinc supplements could enhance DHA synthesis and cell division. It can also enhance the synthesis of proteins that are needed to repair the damaged tissues. Zinc is particularly essential during the stage of the proliferation of wound healing. 

Ornithine

Ornithine can contribute to the production of protein-bound proline in wounds by enhancing the availability of free proline in the extracellular matrix. It can help to accelerate the process of wound healing and help the patients recover in a shorter period.

Conclusion

There are several factors that can slow down or prevent the processes involved in wound healing. It is important to be aware of the impediments to wound healing so that appropriate strategies can be adopted to correct or reverse them in order to promote an efficient closure of the wound in the shorter period.

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  • 2 Responses

    1. Nutrition is what boosts and supports the immune system Not fast foods or high end restaurants with sugar and canola oil that many use. Get good nutrients with supplements Thank you King Arthur USA

    2. Hello Deborah,
      I am always excited reading from you. Do you have a suggested meal plan or dietary guideline you would give for a person who has had a colon surgery to take out Crohn’s disease?

      Thanks

      Mike Ogwal

    Leave a Reply

    Your email address will not be published.

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