1. WOUND CARE AND NUTRITION
Christopher J. Leonard, DO
VP of Medical Affairs
Vohra Wound Management

2. MACRO AND MICRO ENVIRONMENTS
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

3. TOTAL BODY NUTRITION
Food Availability
Food Intake
Nutrient Processing

4. TOTAL BODY NUTRITION
Depression
Dementia
Cognitive Changes

5. TOTAL BODY NUTRITION
Hyperglycemia
Hypoxia
Uremia

6. NUTRITIONAL ASSESSMENT
Visual Inspection and Physical Exam
Cachexia
Obesity (some data shows that morbid obesity had a stronger negative effect than cachexia on wound healing)

7. NUTRITIONAL ASSESSMENT
Verbal Nutritional History
Weight Loss of 10% or greater within six months
Weight Loss used appropriately within clinical scenario

8. NUTRITIONAL ASSESSMENT
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%)

9. NUTRITIONAL ASSESSMENT
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

10. WOUND HEALING Complex Involves protein, carbohydrates, fats
Stress states divert protein up to 30% away from a healing wound

11. NUTRITIONAL NEEDS Calorie Requirements
Daily Protein Needs (assessment is complex)
Carbohydrates and Fat
Micronutrients

12. 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)

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

14. TREATMENT Coordinated Efforts of Nutrition and Wound Care
Nutritional Support Alone Not Adequate
All Patients With Chronic Wounds Should Have A Nutritional Assessment

15. CONCLUSION
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