Nutrition and the Plastic Surgeon: Possible Interventions and Practice Considerations

Abstract

Summary:The objective of this article is to convey the importance of nutrition in plastic surgery, to offer possible outpatient nutritional interventions within the surgical care setting, and to guide the plastic surgeon in integrating nutrition as a key practice enhancement strategy for the care of wound patients and beyond. The impact of nutritional status on surgical outcomes is well recognized. Malnutrition is very frequent among the hospitalized patient population and up to 1 in 4 plastic surgery outpatient is at risk for malnutrition. Micro- and macronutrients are both essential for optimal wound healing and although specific patient populations within the field of plastic surgery are more at risk of malnutrition, universal screening, and actions should be implemented. Outpatient interventions to promote adequate nutritional intake and address barriers to the access of fruits and vegetables have included both exposure and incentive interventions. In the clinical setting, universal screening using validated and rapid tools such as the Canadian Nutritional Screening Tool are encouraged. Such screening should be complemented by appropriate blood work, body mass index measurements, and prompt referral to a dietician when appropriate. The notion of prehabilitation has also emerged with impetus in surgery and encompasses the nutritional optimization of patients by promoting the enhancement of functional capacity preoperatively.

Practical Aspect of Nutritional Support for Wound-Healing Patients : A Comprehensive Systematic Review

“…As true all instances of wound healing, in particular collagen synthesis, provision of adequate energy (to sustain synthetic processes), amino acids (as building blocks for collagen synthesis), oxygen, trace minerals and vitamins (all of which are key for optimal synthetic enzyme function) is key to successful repair. 13,14 Immunonutrition can be defined as the usage of specific nutritional elements in an attempt to modulate the immune system in a way that benefits a certain injury or disease state. In recent years, a number of studies and reviews have evaluated the role of immunomodulating diets (IMDs) or their components in wound healing.…”

Can Preoperative Laboratory Values Predict Short-term Postoperative Complications and Health Utilization in Patients Undergoing Cranioplasty?

“…A study conducted by Xu et al 29 assessed the effectiveness of this intervention in oral and maxillofacial microvascular free flap reconstructions and found that patients receiving perioperative albumin supplementation, in the form of 20% human serum albumin, experienced lower odds of local surgery site complications and shorter postoperative LOS. A consideration for surgeons is to incorporate screening for malnutrition in clinic with validated measures, like the Canadian Nutritional Screening Tool, with blood work or future workup if there is a positive screen 30 . However, low albumin should not be solely tied to malnutrition in patients where there is active inflammation as the liver undergoes reprioritization of protein synthesis in favor of pro-inflammatory cytokines 31 …”

“…A consideration for surgeons is to incorporate screening for malnutrition in clinic with validated measures, like the Canadian Nutritional Screening Tool, with blood work or future workup if there is a positive screen. 30 However, low albumin should not be solely tied to malnutrition in patients where there is active inflammation as the liver undergoes reprioritization of protein synthesis in favor of pro-inflammatory cytokines. 31 In our cohort, both increased hematocrit and albumin significantly reduced the odds of eLOS which is an important consideration as healthcare systems move toward value-based reimbursement models.…”

A Narrative Review of Plastic Surgery and Climate Change: Context and Considerations

“…Larger and longer-lasting wildfires 26 Increasing demand for complex wound and burn care 27 Worsening natural disasters 28 Increasing traumatic injury burden 28 and demand for extremity and hand reconstruction [29][30][31][32] Worsening collective violence 33 Increasing demand for complex reconstruction following violent trauma Rising cancer incidence (eg, breast cancer) 34,35 Increasing demand for cancer reconstruction Strain on global food supply with resulting obesity and malnutrition 36,37 Increased risk for poor wound healing 38,39 Strain on global water supply, irrigation, and sanitation 40,41 Increased risk for postsurgical infection 11 Increasing warm weather 1 Increased risk for surgical site infections 42 order to cater to shifting demands and patient populations. In addition, natural disasters and extreme weather have significantly disrupted hospital operations around the globe, 43,[46][47][48] which may lead to more frequent case cancelations, particularly for elective cases.…”

“…Through the disruption of global food supply, climate change has been linked to poor nutritional status—both obesity and malnutrition, 36,37 which have been shown to worsen wound healing and plastic surgery outcomes. 38,39 Wound infections may also become more prevalent, especially in lower-income nations, as water scarcity threatens irrigation capabilities 38 and flooding threatens the sanitation of water supply. 41 In addition, warm weather itself has been associated with a higher incidence of surgical site infections.…”