Systemic Factors Affecting Repair

Systemic Factors Affecting

Repair

Dorothy Doughty, MN, RN, CWOCN,

FAAN

Systemic Factors Affecting

Wound Healing

Perfusion and

Oxygenation

Oxygen is essential for

all phases of repair

Must address edema,

smoking, and vascular

compromise in order

to promote healing

Systemic Factors Affecting

Wound Repair

Corticosteroids

Profound impairment in healing (dose-related: >30 mg/day shown to cause delayed healing)

Limited evidence that topical vitamin A (25,000 –100,000 IU/day) may help to counteract negative effects

Systemic Factors Affecting

Wound Repair

Diabetes

Negative impact of

hyperglycemia on

repair process

Glycemic goal for most

patients: pre-meal

glucose 80 – 130

mg/dL

Benefits of patient

education, counseling,

contracts

Systemic Factors Affecting

Wound Repair

Smoking/Tobacco Use

Negative impact on

perfusion and healing

Vasoconstriction

Platelet aggregation

Importance of

education, counseling,

and support (including

nicotine replacement

therapy)

Systemic Factors Affecting

Wound Repair

Aging

Comorbidities

Cellular senescence?

Optimal wound care +

PATIENCE

Comorbidities

Adversely affect

repair/prognosis

Must be managed

Systemic Factors Affecting

Wound Healing

Nutritional Status

Essential nutrients:

calories; protein;

vitamins and minerals

Negative impact of

protein-calorie

malnutrition (PCM) or

inadequate nutrient

intake on wound repair

Systemic Factors Affecting

Wound Repair

Nutritional Deficits: Indicators

Unintended weight loss (>5% in 30 days or >10% in 6 months)

Inadequate nutritional intake

Nonhealing wound

Low albumin/prealbumin levels? (more reflective of morbidity/mortality risk than nutritional status)

Nutritional Intervention

Assure referral to Registered

Dietitian Nutritionist (RDN)

Promote nutritional intake (assist

patient at meals; provide

supplements as recommended)

Current guidelines regarding

nutrients needed for repair:

Caloric needs: 30 – 35 cal/Kg

wt/day

Protein needs: 1.25 – 1.5

gm/Kg wt/day

Nutritional Intervention

Nutritional Supplements: Current

Guidelines

MVI daily (limited evidence)

Zinc: short-term

supplementation (2 weeks) IF

patient deficient

Glutamine/l-arginine

supplementation (some data

to support use)

Summary

Systemic Factors/ Status Critical to Repair

Perfusion and oxygenation (particularly relevant for

patient with lower extremity wound)

Smoking cessation

Nutritional status

Glycemic control

Management comorbidities

Topical vitamin A for patient on steroids