Christopher J. Leonard, DOVP of Medical Affairs

Vohra Wound Management

Malnutrition globally translates to the cellular level

Wound healing requires complex biochemical coordination

Depletions of nutrients will impair wound healing

Protein deficiencies will affect wound tensile strength

Energy is required for the healing process

Food Availability

Food Intake

Nutrient Processing

Depression

Dementia

Cognitive Changes

Hyperglycemia

Hypoxia

Uremia

Visual Inspection and Physical Exam

Cachexia

Obesity (some data shows that morbid obesity had a stronger negative effect than cachexia on wound healing)

Verbal Nutritional History

Weight Loss of 10% or greater within six months

Weight Loss used appropriately within clinical scenario

Body Mass Index (BMI): weight (kg)/height (square meters)

Percent Ideal Body Weight: Actual body weight X 100 divided by Ideal Body Weight

Ideal Body Weight: For men is 106 lbs./5 ft. + 6 lbs./additional inch (+/- 10%), for women is 100 lbs./5 ft + 5 lbs./additional inch (+/- 10%)

Albumin (related to total body water, stress, nutrition) and half-life is 28 days

Prealbumin (related to stress and nutrition) and half life is 72 hours

Total Lymphocyte Count Transferrin

Complex

Involves protein, carbohydrates, fats

Stress states divert protein up to 30% away from a healing wound

Calorie Requirements

Daily Protein Needs (assessment is complex)

Carbohydrates and Fat

Micronutrients

Zinc (enzyme cofactor) Copper and Iron (collagen and

hemoglobin) Vitamin A (collagen and steroid issues) Vitamin C (collagen synthesis, common in

elderly population) Glutamine (involved with gut metabolism

and immune function)

Nutritional Screening Consultation with Registered Dietitian Patient Education/Dietary Instruction Meal Planning Nutritional Supplements Calorie Counts

Coordinated Efforts of Nutrition and Wound Care

Nutritional Support Alone Not Adequate All Patients With Chronic Wounds Should

Have A Nutritional Assessment

All patients with chronic wounds should have a nutritional screen

All patients with chronic wounds who are deemed at risk for malnutrition should have a full nutritional assessment

Nutrition is part of a complex process in wound healing, but only one component

Base treatment on scientific evidence