Role of nutrition in wound closure: a case report

Abstract

Malnutrition is a common risk factor in chronic wounds due to its long healing period and it should be considered in their prevention. Nutrition during the wound-healing process should be adequate for the increased demand. The objective from this study is to present a case report of the evolution of a chronic infected wound after multidisciplinary management, including surgical approach, antibiotic therapy, and nutrition for its resolution. A 43-year-old female who begins with sudden pain in the left inguinal region associated with swelling. She received analgesic treatment without improvement and decided to attend the hospital where is diagnosed with septic shock secondary to soft tissue infection. Surgical drainage was done and a vulvar abscess was found, dissecting from the mount pubis to the ischiopubic fossa with necrotic tissue and fetid purulent material. In the postoperative period, multiple surgical lavages and debridements were carried out, followed by a VAC system. Nutritional parameters were below the acceptable level, parenteral nutrition was started and enteral nutrition with arginine boluses. Admission to the nutritional support service with parenteral nutrition and subsequently switching to enteral nutrition with arginine support raised their levels according to the improvement of the wound previously reported. Nutrient deficiency has been found in patients with chronic wounds and although the role of nutrition has not been adequately established, clinical improvement can be attributed to the establishment of treatment with complementary nutrition. Due to the good clinical response of our patient, we suggest formulas supplemented with arginine as part of the complete treatment (medical and surgical). The use of arginine dietary supplements in surgical patients leads to a consistent and significant reduction in postoperative infections.