Few practitioners dispute the importance of adequate nutrition for promoting wound healing. However, despite the assumption that vitamin and mineral supplements may aid in healing these wounds, few studies have addressed the potential benefits of supplementation in a rigorous fashion. Vitamin C supplements are often prescribed for patients with chronic wounds. Presumably, the well-known effects of excessive ascorbic acid deprivation, as seen in scurvy, include a susceptibility to non-healing wounds. Some reports have evaluated the use of vitamin C as an adjunctive wound-healing agent, with mixed results, and failed to demonstrate a clear benefit of vitamin C supplements in patients with chronic wounds of all types.19,20
Zinc has been used for more than a century as a topical adjunct for the care of chronic wounds.21 Unna believed that the zinc paste in his boots had a beneficial effect on healing; however, it now appears more likely that the continued popularity of the Unna boot for patients with venous leg ulcers stems from its compressive effects on the lower leg in patients with venous ulcers.22 Oral zinc for the treatment of venous ulcers has been addressed in a Cochrane collaborative review evaluating six trials of oral zinc therapy, most of which failed to show a beneficial effect of therapy.23 Five of these studies included patients with venous ulcers. The doses of zinc varied across studies. A study by Greaves et al. failed to demonstrate a significant benefit of oral zinc therapy, with a relative risk of healing of 1-5 (CI 0-28-7-93).24 The remaining studies also failed to show a benefit of zinc therapy.23,25,26
Topical zinc has also been evaluated as a treatment for venous ulcers. One study suggested that topical zinc oxide improves healing in both arterial and venous ulcers.21 However, a study in porcine skin suggested that the only beneficial action of zinc on the wound bed was that it inhibited bacterial growth.27
Several studies have addressed the efficacy of rutinoids in decreasing the oedema associated with venous insufficiency.28-33 Results appear to be promising, and these drugs may be useful in patients with venous ulcers, since these wounds generally cannot heal in the setting of persistent oedema. Moreover, reducing the oedema of venous insufficiency may reduce the likelihood of future wounds.
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