From the Guidelines
Tobacco smoking and poor nutrition significantly impair wound healing, and cessation of smoking and optimization of nutritional status are crucial for promoting healing and preventing complications. Smoking constricts blood vessels, reducing blood flow to the wound site and limiting the delivery of oxygen and nutrients essential for healing, as evident in a study published in the Journal of the National Comprehensive Cancer Network, which found that current smokers had higher postoperative rates of pneumonia, failure to wean from ventilator, reintubation, and cardiorespiratory failure compared to former smokers 1. The carbon monoxide in cigarette smoke binds to hemoglobin, further decreasing oxygen availability to tissues. Nicotine specifically delays wound healing by increasing inflammation and inhibiting the formation of new blood vessels.
Poor nutrition, particularly deficiencies in protein, vitamins A, C, and zinc, compromises the body's ability to form collagen, fight infection, and generate new tissue. A study published in Clinical Nutrition found that supplementation with oral nutritional formulas enriched with arginine, zinc, and antioxidants improved pressure ulcer healing in malnourished patients 1. Without adequate protein, the body cannot build new cells or repair damaged tissues. Vitamin C deficiency impairs collagen synthesis, while zinc deficiency reduces cell proliferation and wound strength.
Key factors that contribute to impaired wound healing in smokers and malnourished individuals include:
- Reduced blood flow and oxygen delivery to the wound site
- Increased inflammation and delayed formation of new blood vessels
- Impaired collagen synthesis and tissue repair
- Increased risk of infection and complications
- Prolonged healing time and potential for chronic, non-healing wounds
To promote optimal wound healing, it is essential for patients to stop smoking completely and maintain a balanced diet rich in protein, fruits, vegetables, and essential nutrients, or consider appropriate supplements if dietary intake is inadequate. Early screening for malnutrition and nutritional interventions can support healing in malnourished patients with pressure ulcers, as highlighted in a study published in Clinical Nutrition, which found that nutritional interventions may depend on nutritional status and concomitant relevant health problems causing the pressure ulcers 1.
From the Research
Effects of Tobacco Smoking on Wound Healing
- Tobacco smoking can impede the wound healing process by reducing tissue oxygenation and aerobic metabolism, as well as attenuating the inflammatory healing response 2, 3, 4.
- Smoking can lead to a decrease in inflammatory cell chemotactic responsiveness, migratory function, and oxidative bactericidal mechanisms, ultimately resulting in delayed healing and complications 4.
- The release of proteolytic enzymes and inhibitors is also imbalanced in smokers, further impairing the wound healing process 4.
Effects of Poor Nutrition on Wound Healing
- Poor nutrition can significantly impede the wound healing process, with malnutrition leading to decreased wound tensile strength and increased infection rates 5, 6.
- Key nutrients such as proteins, vitamins (A, C, E, K), and minerals (zinc, iron, copper, manganese) are essential for collagen synthesis, immune function, and cellular activity, and deficiencies in these nutrients can hinder wound healing 6.
- Nurses play a crucial role in assessing nutritional status, implementing dietary interventions, and educating patients and caregivers about the importance of nutrition in wound care 6.
Combined Effects of Tobacco Smoking and Poor Nutrition on Wound Healing
- Both tobacco smoking and poor nutrition can have a synergistic effect on wound healing, leading to delayed healing, increased infection rates, and decreased wound tensile strength 2, 3, 5, 4, 6.
- A multidisciplinary approach is critical to optimise nutritional support and improve patient outcomes in wound healing, particularly in patients who smoke and have poor nutrition 6.