Drug and nutrient aspects of wound healing.

An understanding of the major factors that influence wound healing enables the clinician to better prepare patients for surgery and to identify and correct the effects of either drugs or nutritional imbalances in patients whose wounds fail to heal. Ideally, factors that enhance wound healing should be optimized, and detrimental influences minimized whenever possible. Among the major factors influencing wound healing are the state of general health, drugs, and nutritional status. Nutritional assessment prior to surgery, following injury, and during recovery is an important part of management of patients with extensive wounds. In dermatologic surgical practice, nutritional support is not indicated; however, subclinical nutritional deficiencies may not be uncommon and may become relevant if wound healing is significantly impaired. Dermatologic surgeons must be aware of the potential for many drugs to interfere with wound healing and interrupt therapy prior to surgery whenever possible. Some drugs cannot be stopped and surgery should be performed only when absolutely necessary when patients are receiving antineoplastic, anticoagulant, and high-dose steroid therapy.