Healing of wounds, whether from accidental injury or surgical intervention, involves the activity of an intricate network of blood cells, tissue types, cytokines, and growth factors. This results in increased cellular activity, which causes an intensified metabolic demand for nutrients. Nutritional deficiencies can impede wound healing, and several nutritional factors required for wound repair may improve healing time and wound outcome. Vitamin A is required for epithelial and bone formation, cellular differentiation, and immune function. Vitamin C is necessary for collagen formation, proper immune function, and as a tissue antioxidant. Vitamin E is the major lipid-soluble antioxidant in the skin; however, the effect of vitamin E on surgical wounds is inconclusive. Bromelain reduces edema, bruising, pain, and healing time following trauma and surgical procedures. Glucosamine appears to be the rate-limiting substrate for hyaluronic acid production in the wound. Adequate dietary protein is absolutely essential for proper wound healing, and tissue levels of the amino acids arginine and glutamine may influence wound repair and immune function. The botanical medicines Centella asiatica and Aloe vera have been used for decades, both topically and internally, to enhance wound repair, and scientific studies are now beginning to validate efficacy and explore mechanisms of action for these botanicals. To promote wound healing in the shortest time possible, with minimal pain, discomfort, and scarring to the patient, it is important to explore nutritional and botanical influences on wound outcome.
"Vitamin A is an agent known to be required for epithelial tissue development, and it also facilitates normal wound repair. Vitamin C is an essential cofactor of collagen synthesis and other components of connective tissues and plays an important role in the wound healing process. "
[Show abstract][Hide abstract] ABSTRACT: The aim of this study is to investigate the effect of vitamin A and C, as the agents that improve wound healing, on the adhesion formation process.
Sixty male Wistar rats were used. They underwent midline laparotomy, for repair of a peritoneal injury, and were then assigned to four groups. Group 1 (Vitamin A) received 2000 units/kg intramuscular injection of vitamin A daily, post surgery, for two weeks; Group 2 (Vitamin C) received 100 mg/kg oral vitamin C daily, after laparotomy, for two weeks; Group 3 (vitamins A and C) received 2000 units/kg intramuscular injection of vitamin A and 100 mg/kg oral vitamin C daily, after laparotomy, for two weeks, and Group four (Sham) rats did not receive any drugs. The adhesion, inflammation, fibrosis scores, and wound integrity were evaluated after two weeks.
Rats in the vitamin C group had the lowest mean adhesion formation score (1 ± 0.27) and the values of p were < 0.0001 for the vitamin A group and vitamin A and C groups and 0.003 for the sham group. Vitamin C also had the lowest fibrosis score (0.50 ± 0.17) among the study groups and the values of p were < 0.0001 for the vitamin A group and vitamin A and C groups and 0.002 for the sham group. The mean inflammation score did not differ significantly among the study groups. The wound disruption strength was the highest in the vitamin C group and the difference was statistically significant in the sham group (1188.69 ± 281.92 vs. 893.04 ± 187.46, p : 0.003).
Administration of oral vitamin C reduces adhesion formation and improves wound healing.
Journal of research in medical sciences 01/2014; 19(1):28-32. · 0.65 Impact Factor
"Bromelain (pineapple enzyme, Ananas comasus) is an aqueous extract obtained from the stem and fruit of the pineapple plant that contains high levels of proteolytic enzymes and which composition varies depending on the source and purification method (1,2). Bromelain directly influences pain mediators such as bradykinin (3), although its analgesic properties are closely linked to its anti-inflammatory properties (4,5). It has beenshownthat this fibrinolytic agent promotes reabsorption of edema in the blood circulation (6); it reduces swelling, bruising, pain, and healing time after trauma and surgical procedures (5). "
[Show abstract][Hide abstract] ABSTRACT: Objectives: To evaluate the anti-inflammatory and analgesic effect of Bromelain (pineapple extract) administered orally in the postoperative after extraction of impacted lower molars.
Study Design: This is a prospective, placebo-controlled, unicentric, double-blind study; the sample size was 34 patients. The pre and postoperative outcomes, evaluated on the third (D3) and eighth day (D8), included inflamtion, pain and oral aperture, as well as the need for analgesics. One group received bromelain 150mg per day for three days and 100mg on days 4 to 7. The other group received placebo in the same dosage. All outcomes werrecorded quantitatively and analyzed with the Mann-Whitney U test for independent samples.
Results: Although there were no statistically significant differences between the treatment groups, a trend towards less inflammation and improved oral aperture was observed in the group that received bromelain, compared to the group that received placebo. This trend can be attributed completely to random reasons, since there is no statistical difference in the results.
Conclusions: Further studies are necessary to analyze different administration patterns and doses of bromelain for the use in the postoperative of impacted third molars.
Key words:Tooth extraction, third molar, postoperative period, bromeline, clinical study.
"Such substantial evidence supports the use of this vitamin as a preoperative nutritional supplement (MacKay and Miller, 2003). Secondly, vitamin C (or ascorbic acid) enhances neutrophil function (MacKay and Miller, 2003) and when supplemented at least at 1 g per day, it is correlated with improved immune cell (cell mediated immunity and phagocytosis) function (Casciari et al., 2003). The action of secondary metabolites on immune system has not been studied extensively but, the anti-inflammatory activity of flavonoids has been shown to be attributed to their ability to inhibit neutrophil degranulation; diminishing the release of arachidonic acid and other mediators from immune cells (Nijveldt et al., 2001). "
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