What vitamins are recommended for wound healing?

Vitamins for Wound Healing

Vitamin C is the most important vitamin for wound healing due to its role in collagen synthesis, but supplementation is not recommended as standard care for wound healing unless there is a documented deficiency.

Key Vitamins and Their Roles in Wound Healing

Vitamin C

• Functions as the most potent water-soluble antioxidant that directly scavenges radicals and is an essential cofactor for collagen synthesis 1
• Protects the endothelium by promoting collagen synthesis and maintaining endothelial vasodilation and barrier function 1
• Improves wound healing through its role in limiting inflammatory response and enhancing host defense 1
• Deficiency can significantly impair wound healing by affecting collagen production 2
• Research suggests that a vitamin C intake of 75-110 mg/day may be needed to prevent collagen-related pathologies, higher than the WHO recommendation of 45 mg/day 3

Vitamin A

• Important for epithelial and bone formation, cellular differentiation, and immune function 4, 5
• Stimulates epithelial growth, fibroblasts, granulation tissue, angiogenesis, collagen synthesis, and fibroplasia 4
• Both topical and systemic supplementation has been shown to increase dermal collagen deposition in animal studies 4
• Most commonly used to offset the negative effects of steroids on wound healing 4
• Recommended enteral nutrition should provide 900-1500 mg RE (Retinol Equivalents) per day when providing 1500 kcal per day 1

Other Important Micronutrients

• Vitamins B-1, B-6, B-12, D, and E, as well as iron, copper, selenium, and zinc are thought to improve wound healing and immune function 1
• Zinc plays a specific role in wound healing through its involvement in protein and collagen synthesis 5

Evidence-Based Recommendations

For General Wound Healing

• Do not use pharmacological agents that supplement vitamins and trace elements to improve wound healing outcomes over standard care 1
• The International Working Group on the Diabetic Foot (IWGDF) strongly recommends against using vitamin and trace element supplements for diabetic foot ulcers (Strong recommendation; Low quality evidence) 1
• Studies evaluating vitamin supplementation for wound healing were found to be at moderate or high risk of bias 1

For Specific Patient Populations

• For surgical patients, particularly those with burns, vitamins A, C, D, and minerals like zinc may be considered due to their role in wound healing and immune function, although more research is needed 1
• In major burn patients, especially those requiring continuous renal replacement therapy, monitoring of key micronutrients (including vitamins B-1, B-6, and C) is encouraged 1
• For patients with pressure ulcers, protein or amino acid supplementation is recommended to reduce wound size (weak recommendation, low-quality evidence) 1

Clinical Considerations and Pitfalls

When to Consider Vitamin Supplementation

• Consider vitamin supplementation only in patients with documented or suspected deficiencies 1, 2
• Patients with malabsorption conditions may benefit from vitamin A supplementation to prevent deficiency 1
• After wounding, plasma and tissue levels of vitamin C diminish, and supplements may be useful for healing in deficient patients 2

Potential Risks and Monitoring

• Vitamin A toxicity can occur with excessive supplementation: acute toxicity with >300,000 IU in adults within a few hours/days, chronic toxicity with >25,000 IU daily for >6 years 1
• The upper limit for vitamin A is set at 3000 mg/d (10,000 IU) for women of childbearing age 1
• Monitor serum retinol and retinyl esters in patients being investigated for malabsorption 1
• For parenteral nutrition, vitamin A is light sensitive and may undergo photo-degradation, requiring light-protecting material during administration 1

Alternative Approaches to Wound Healing

• Hydrocolloid or foam dressings are recommended for reducing wound size in pressure ulcers (weak recommendation, low-quality evidence) 1
• Electrical stimulation is recommended as adjunctive therapy to accelerate wound healing (weak recommendation, moderate-quality evidence) 1
• For post-surgical diabetes-related foot wounds, negative pressure wound therapy may be considered as an adjunct therapy 1

Despite the theoretical benefits of vitamins in wound healing, current high-quality evidence does not support routine supplementation unless there is a documented deficiency. Standard wound care remains the cornerstone of treatment.