Ascorbic acid deficiency impairs wound healing in surgical patients: Four case reports

• Ascorbic acid plays a pivotal role in collagen synthesis and thus wound healing.
• Invasive circumstances (surgery, infection, sepsis) could induce an ascorbic acid deficiency.
• Ascorbic acid should be measured before or after surgery in patients at risk.
• Supplementation with 1000 mg dd ascorbic acid improves wound healing drastically.
• Supplementation could greatly reduce discomfort and costs of elaborate wound treatment.

BackgroundVitamin C or ascorbic acid (AA) is the antiscorbutic factor preventing scurvy. It is essential for collagen synthesis, serving as cofactor in the enzymatic conversion of procollagen into collagen.Scurvy is regarded as something from the past; however, patients with low or subclinical levels of AA are frequently seen in our hospital. A subclinical deficiency will not often cause the display of the hallmark symptoms of scurvy, but this may lead to an altered collagen synthesis and have major implications for adequate wound healing, such as in the surgical field.Case summaryAA was measured by HPLC using UV detection (Recipe) in a teaching hospital surgical patient group (n = 180) within a week pre- or post-surgery. Over a period of 21 months we found AA levels below the reference limit (25 umol/L) in 65 out of 180 patients (36%). Four patients described in detail initially showed poor wound healing. Their AA levels were 8, 4, and 19 umol/L respectively. After starting supplementation (1000 mg/day) a dramatic and fast recovery of extensive and complicated wounds was observed by patients and their clinician. Supplementation was ceased after the wounds were completely healed.ConclusionAA deficiency is not uncommon in the hospital population, especially in those at risk. Treating deficient patients with AA leads to swift improvement of the wound healing process post-surgery, thereby reducing the costs of extensive wound treatment and extended stay in hospital.