Christopher J. Leonard, DO VP of Medical Affairs Vohra Wound Management
Mar 26, 2015
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