From the Guidelines
Vitamin C plays a crucial role in wound healing for surgical patients by supporting collagen synthesis, which is essential for tissue repair and wound strength. For optimal surgical outcomes, patients should maintain adequate vitamin C levels, with a recommended daily intake of 75-90 mg for general health, though higher doses of 500-1000 mg daily may be beneficial before and after surgery 1. Vitamin C functions as a cofactor for enzymes involved in collagen formation, enhances immune function by supporting white blood cell activity, and acts as an antioxidant to reduce oxidative stress at the wound site 1. It also improves iron absorption, which supports oxygen delivery to healing tissues. Deficiency can significantly impair healing, leading to complications like wound dehiscence or infections. Patients with poor nutritional status, smokers, and those with chronic diseases may particularly benefit from supplementation. While oral supplementation is typically sufficient, severely deficient patients may require intravenous administration in the perioperative period to ensure optimal wound healing.
Some key points to consider in the context of vitamin C and surgery include:
- Clinical conditions with increased inflammation and oxidative stress, such as sepsis, trauma, cardiac arrest, major surgery, and chronic dialysis, are associated with a high risk of vitamin C depletion 1
- Burn patients, those undergoing bariatric surgery, and patients with severe sepsis and acute respiratory failure may require higher doses of vitamin C, ranging from 200 to 500 mg/day or even 200 mg/kg/day for 4 days in severe cases 1
- Vitamin C has been shown to limit the inflammatory response and ischemia-reperfusion injury, improve host defense, wound healing, and mood, and has a role in pain reduction 1
- Nutritional optimization of the surgical patient, including vitamin C supplementation, is crucial for improving outcomes, reducing complications, and enhancing recovery 1
Overall, maintaining adequate vitamin C levels is essential for optimal wound healing and surgical outcomes, and supplementation should be considered in patients at risk of deficiency or with increased requirements.
From the Research
Role of Vitamin C in Wound Healing
Vitamin C, also known as ascorbic acid, plays a crucial role in wound healing for patients undergoing surgery. The key aspects of its involvement include:
- Requirement in all phases of wound healing, from the inflammatory phase to the maturation phase 2
- Contribution to collagen synthesis, maturation, secretion, and degradation during the proliferative phase 2
- Impact on neutrophil apoptosis and clearance in the inflammatory phase 2
Nutritional Recommendations for Wound Healing
Recommendations for vitamins, including vitamin C, and other nutrients such as zinc, protein, and arginine, highlight their importance in the wound healing process 3. Specifically, vitamin C is necessary for:
Evidence for Vitamin C Supplementation
Studies suggest that vitamin C supplementation can accelerate wound healing in subjects not deficient in vitamin C, with daily dosages ranging from 500 to 3,000 mg 5. Additionally, genetic impairments of collagen synthesis have been shown to respond to ascorbic acid supplementation 5. However, it is essential to note that excessive levels of vitamin C beyond saturation are excreted, and clinicians should be aware of the patient's nutritional status and potential deficiencies 2.
Comparison with Other Nutrients
While vitamin C is crucial for wound healing, other nutrients like vitamin A also play significant roles. Vitamin A is involved in epithelial growth, fibroblasts, granulation tissue, angiogenesis, collagen synthesis, epithelialization, and fibroplasia 6. In contrast to vitamin C, the evidence for vitamin A supplementation is currently limited to expert opinion and lacks rigorous trials 6.