Surgeons understand the science behind healing. Nutritional building blocks are necessary to rebuild and repair surgically traumatized tissue. As the surgeon, what do you to ensure your patients are nutritionally maximized at the time of surgery to have the best chance for an optimal recovery?
You review their medical history for conditions and habits that may lead to complications but do you review their nutritional status, which can promote healthy healing? Poor and unbalanced eating habits can lead to nutritional deficiencies. Stress can suppress one’s appetite before and after surgeries. If patients do not have proper nutrition, then this theoretically sets the stage for healing difficulties.
When it comes to surgically “traumatized tissue,” we know the body has to rebuild and repair tissue on the cellular level. This involves energy and nutritional building blocks to support the healing process. Of course, the more involved the surgery, the more demands fall on the body. Healing starts at the moment of injury and involves a series of orchestrated biomechanical reactions.
We know that healing occurs in three distinct overlapping phases with the bulk of healing occurring within the first few weeks following surgery.
Inflammatory phase (up to five days). This is the first response to injury. A localized blood clot forms to stop bleeding. Infection fighting cells (neutrophils) and debris cleaning cells (macrophages) invade the area.
Proliferative phase (two days to three weeks). Tissue building begins with fibroblasts to produce collagen. Collagen is a specialized chain of amino acids, which is the main component in many tissues such as skin, tendon, muscle, ligaments, cartilage, blood vessels, bone, intervertebral disk, teeth and more. Collagen is “stronger than steel wire” and improperly formed collagen is associated with healing disturbances.
Remodeling phase (three weeks to years). The body transforms and replaces the collagen that the body generated during the proliferative phase into a stronger collagen to support structure and function over the long term.
There is a theoretical benefit to being as healthy as possible and nutritionally maximized prior to surgery to support optimal healing. While the body uses several vitamins, minerals and amino acids during healing, there are specific ones that are specifically known to support both the normal response to healing and the normal immune system response to infection.
Vitamin C. Vitamin C is necessary to build and rebuild collagen throughout the body. Vitamin C is also a powerful antioxidant that supports the immune response.
Vitamin A. Vitamin A supports immune system functioning and aids collagen strength. It is also required for bone development.
Zinc. Zinc is an essential trace mineral used in enzymatic reactions involved in tissue and wound healing, regeneration and repair.
Vitamin K. Vitamin K aids the natural blood clotting response and is important for bone health.
B vitamins. B vitamins enhance cellular metabolism, tissue repair and immune support.
Vitamin D and calcium. These are important for bone health.
Magnesium. Magnesium is a mineral involved in approximately 300 biochemical reactions.
Amino acids (L-arginine, L-glutamine). These are two key amino acids for wound repair and immune function.
Vitamin E and surgery do not mix because vitamin E is associated with increased bleeding and this can lead to hematoma, which could result in serious complications. Patients should not take vitamin E preparations before surgery.
Patients should avoid herbal supplements in general prior to surgery because they can cause bleeding or other operative complications. A few commonly taken herbal supplements to avoid are: ginkgo biloba, garlic, ginseng, ginger, dong quai, ephedra, feverfew, St. John's wort and/or omega 3 fatty acids.
A general rule is to advise patients to stop taking these potentially unsafe preparations at least two weeks prior to surgery.
Surgeons should specifically consider their patients’ nutritional status as part of the preoperative evaluation. Both the patient and surgeon want the best healing possible, especially when it comes to elective surgeries. An emphasis on surgical nutrition starts before surgery and should continue until the patient has achieved sufficient healing, a process that could take several weeks.
A proper, healthy, balanced diet is the best offense as far as healing properly. Providing any dietary supplements is not a substitute for eating healthy. Another benefit of adding surgical nutritional supplements is that it gets your patients actively involved in the healing process, something that most will appreciate.
In summary, healing is complex but the concept for surgical nutritional support is simple: provide the building blocks for healing in order to optimize the healing efforts. Whether you encourage your patients through diet or the addition of targeted dietary supplements, there is a benefit for patients to be nutritionally healthy to support the body’s natural healing efforts associated with surgery.
Dr. Blitz is the Chief of Foot Surgery and Associate Chairman of Orthopaedics at Bronx-Lebanon Hospital Center in New York City. He can be reached at firstname.lastname@example.org  .
Dr. Blitz is the Founder and President of Surgery Vitamin, LLC. To learn more about Surgery Vitamin Products, visit www.surgeryvitamin.com  .