Wound Ascorbic acid deficiency

In contrast, studies on the effect of ascorbic acid deficiency on the sequence of wound repair in guinea pig (D21) showed an initial decrease in amount of hexosamine and absence of metachromasia. Fibroblasts were poorly oriented and immature, and no collagen formation took place. By the twelfth day, the absence of coUagen and the presence of immature fibroblasts were established, and hexosamine content was found to be high instead of low as in normal repair. 

A7. Anonymous, The chemical and physical effects of ascorbic acid deficiency on the tissues during wound healing. Nutrition Revs. 17, 286-287 (1059). 

Ascorbic acid, a water-soluble vitamin (1(X) to 250 mg p.o. daily), is indicated in the treatment of frank and subclinical scurvy in extensive bums, delayed fracture or wound healing, postoperative wound healing severe febrile or chronic disease states and in prevention of ascorbic acid deficiency in those with poor nutritional habits or increased requirements. In addition, ascorbic acid has been used for potentiation of meth-enamine in urine acidification and as an adjunctive therapy in the treatment of idiopathic methemoglobinemia. 

Vitamin C (ascorbic acid) functions as an antioxidant and as a cofactor for hydroxyla tion reactions in procollagen. A deficiency of vitamin C results in scurvy, a disease char acterized by sore, spongy gums, loose teeth, and poor wound healing. There is no known toxicity for this vitamin. 

Ascorbic acid is synthesized by plants and many ani- mals but not by primates or guinea pigs. In scurvy, the disease associated with a severe deficiency of ascorbic acid, connective tissues throughout the body deteriorate. Weakening of the capillary walls results in hemorrhages, wounds heal poorly, and lesions occur in the bones. 

Vitamin C (L-ascorbic acid Figure 37.41) can limit melanin production, as it has a tyrosinase-inhibiting and antioxidant activity. Skin cells naturally use ascorbic acid in energy metabolism and when synthesizing collagen. A deficiency in vitamin C is a well-known cause of many disorders, including hyperkeratotic folliculitis and delayed wound healing. 

Adult scurvy develops exactly like that observed in the experimental human cases. Its effects are often more severe because they are more prolonged, and because the patients are debilitated by age, other diseases, and associated deficiencies. Purpura and ecchymoses develop at the sites of minor trauma on the lower extremities, and there are hemorrhages into muscles and joints. The gums become swollen, blue-red, and bleed easily, but only around teeth whose looseness provides the mechanical strain needed to initiate the lesion. Old ulcers break down, recent scars of apparently healed wounds become red and hemorrhagic and new wounds fail to heal. Death often occurs suddenly from minor precipitating reasons. The prompt administration of ascorbic acid in curative amounts can be lifesaving. 

Because wounds fail to heal in scurvy, ascorbic acid has been administered routinely to surgical cases, usually in the absence of any evidence that the tissues of the patients were depleted of the vitamin. Yet the observations of Crandon et al. (1940) make it clear that it requires a really severe dietary deficiency of the vitamin to produce any impmrment in the healing of wounds. If any measurable amount of ascorbic acid is present in the plasma, it is most unlikely that doses of ascorbic acid wUl make any difference to the rate of healing or the strength of the scar. The present writer disagrees, in this matter only, with the views of Hunt (1941). 

The hypothesis that ascorbic acid is required for the synthesis of PHI and is itself destroyed in the course of the synthesis explains why in such conditions as inflammation, wound repair, and cancer the individual always appears to be deficient in ascorbic acid, on the basis of measurement of its concentration in the serum, measurement of urinary excretion, and saturation tests [2, 7, 18]. It is clear that the total body requirement of ascorbic acid has become abnormally high, as would result from an increased synthesis of PHI with incorporation or destruction of ascorbic acid. 

Water-Soluble Vitamins. Vitamin G (ascorbic acid) functions in the formation of collagen, wound healing, metabolic functions, and other roles. Foods high in vitamin G include citrus fruits, strawberries, cantaloupe, and cruciferous vegetables. B vitamins are important in energy metabolism. Thiamin (Bj) is called the antineuritic vitamin. Riboflavin (B ), rarely deficient in the diet, is found most abundantly in milk and dairy products. Niacin (Bj) is prevalent in meats, poultry, fish, peanut butter, and other foods. Other major B vitamins include folic acid (B ), B, and Bj2-... 

A water soluble vitamin which cannot be synthesized by man and therefore has to be obtained from the diet. It is found extensively in vegetables and fruit, especially the citrus varieties. Since the vitamin is carried mainly in the leukocytes, its measurement in these cells gives some indication of the vitamin C status of the body. The ascorbic acid saturation test can also be used to assess the vitamin status. The biochemical role of the vitamin is obscure although it does seem to be required for collagen formation. Deficiency of the vitamin causes scurvy, the symptoms of which can be related to poor collagen formation. These include poor wound-healing, osteoporosis (due to bone matrix deficiency), a tendency to bleed (due to deficiences in the vascular walls) and anaemia. 

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