Plastic surgery,Burns and nutrition

1. Co-relation Between Nutrition
and Plastic Surgery
Rajpal Singh
MCh (Plastic & Reconstructive Surgery)
Choithram Hospital, Indore

2. INTRODUCTION
1. 50 % of patients are malnourished on admission.
2. Only 20% of patients received a nutritional consult.
3. 3 times more chances of increased morbidity and 4
times more chances of death compare to well nourished
surgical patients.
4. Hospital stays are longer and health care cost can be
more than 60% for malnourished patients.

3. NUTRITION
Definition
The taking in and metabolism of nutrients (food and
other nourishing material) by an organism so that life is
maintained and growth can take place.
Dorland’s PocketMedical Dictionary

4. MALNUTRITION
Definition
A disorder of nutrition or a wasting condition resulting
from energy and protein deficiency, sometimes with
vitamin and trace element deficiency as well.
Dorland’s Pocket Medical Dictionary

5. MALNUTRITION CAUSES
Reduced food intake
 anorexia
 fasting
 pain on swallowing,
 physical or mental impairment
Malabsorption
 impaired digestion or absorption
 excess loss from gut
Altered metabolism
 trauma
 burns
 sepsis
 surgery
 cancer cachexia

6. The Stress of Surgery
1. Surgery poses a metabolic stress on the body.
2. Trigger inflammation deplete nutrition can impair
immune response and can cause post op. complication.

7. IMPORTANCE OF
NUTRITION IN SURGERY
1. Surgical procedures (and subsequent fasting) after admission can
cause these patients to go into severe malnutrition quickly, often
before the treating team realizes it.
2. There is evidence that patient with severe protein depletion have
greater incidence of postoperative complication such
pneumonia, wound infection, & prolonged hospital stay.

8. OBJECTIVE OF NUTRITIONAL SUPPORT
1. Provide nutrition support consistent with patient’s medical
condition
2. Prevent/ treat macronutrient and micronutrient deficiency
3. Provide doses of nutrient compatible with existing metabolism
4. Avoid/ manage complications related to the technique of
nutrient delivery.
5. To prevent and minimize the effect of catabolism.

9. ASSESSMENT OF NUTRITIONAL STATUS
Nutritional assessment
Depleted reserves
Muscle wasting, loss of
subcutaneous fat, albumin<
30 g/L, weight loss 10-15%.
Poor current intake
Anorexia/vomiting,
poor intake on
food chart
NUTRITIONAL
SUPPORT
Likely clinical course
If not going to eat within next 5
days, if already malnourish and
at risk of further major
complication such as
abscess/fistula

10. Nutrition and Plastic Surgery
Three major factor causes change in nutritional m/m
1. Understanding of technique of I/V hyper alimentation
or TPN
2. Recognition of PCM in hospitalized pt.
3. Quantification of nutritional deficits

11. Applications to plastic surgery
HEAD and NECK SURGERY
• Especially in cancer,major facial trauma,IMF pt hv
poor oral intake,malnutrition +
• NG or cervical pharyngostomy for feeding
• TPN if entral feeding is not possible

12. Burns :
Most challenging, Super hypermetabolic state
• Elevated catecholamine, produces glucagon excess
results in catabolic effect so metabolic debt is paid
principally from body’s protein results in loss of muscle
mass
• Enteral feeding is best way to maintain nutrition, pt
needs 1.5 times of basal level
• Vitamin dose should be given at therapeutic level

13. • A high protein, high calorie diet with high calorie
density oral supplements at intervals proves successful
• If voluntary diets fails, TUBE feeding can be a way

14. Cancer Chemotherapy/Chronic Wounds
• Nutritional assessment and m/m is equally imp as
treatment in pt on cancer chemo induced anorexia or pt
with paraplegia with pressure sore or multiple trauma pt

15. The Plastic Surgery Diet - Take Home Message
• Proper nutritional habits should starts as early as one
month before surgery
• One week before surgery, AVOID foods that could react
with anesthetics, bleeding, immunity or healing time
• After surgery the diet should follow is ideally, the one
you make following a month before surgery

16. The Plastic Surgery Diet - Take Home Message
• Diet should be palatable, easily available, cost effective.
• Recent literature review found no statistical difference in
infections, complications and length of hospital stay b/n
patients given oral nutritional supplements or immuno
nutritional supplements.

17. The Plastic Surgery Diet - Take Home Message
• Patients who have lost more than 5 % of their weight in
last 1 to 3 months, have a BMI of less than 18.5 and
reduction in food intake (25 - 75%), take steroids, have
cancer or immuno separation, They are high nutrition
risk patients need to be taken care.

18. Being Nutritionist…
As per words said by DAVID EVANS from Ohio
State University “Nutritionist should bring evidences
that will encourage surgeons to buy NUTRITION
PROTOCOLS, these recommendations are known
as ERAS or “enhanced recovery of patient after
surgery urges-Preoperative nutrition assessment
and counseling, prebiotic/probiotics adminstration,
limiting preoperative fasting to 2 to 3 hours rather
then routine 6 to 12 hours and immediate post op
fluid and diet initiation

19. "Surgery is like a sport, Evans said,
"and we have to be the trainers.
If you're not well trained,
if you're not ready for surgery,
you're not going to do well."

20. Keep Smiling !