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Skin Integrity and Pressure Injuries

Powdered Arginine Supplement

Alternative medicine often relies on nutritional supplements to augment deficiencies in disease states. Because the exudate of pressure injuries are a source of bodily protein loss, daily intake of up to 2.0 g/kg of protein for individuals at risk of pressure injury development is advocated by Van Anholt et al. (2010). Similarly, supplementation with amino acids that act as substrates for protein synthesis and subsequent nitrogen balancing may also promote pressure injury healing. Brewer et al. (2010) undertook to test the effectiveness in supplementing individuals with SCI with the semi-essential amino acid, arginine, for improvement in pressure injury healing.

Author Year
Country
Research Design
Sample Size

Methods

Outcome

Brewer et al. 2010
Australia
Pre-post
N=35
Population: Mean age= 50.5 yr; Gender: males=34, females=1; Level of injury: paraplegic=25, quadriplegic= 10; Wound status: grade II ulcer= 10, grade III ulcer=14, grade IV ulcer= 6.
Intervention: 9 g commercial powdered arginine supplement per day.
Outcome Measures: Healing rates.
1. Time to healing took an average of 21.1 wk in the historical control group.
2. Time to healing took an average of 10.5 wk in the intervention (powdered arginine supplement) group.

Discussion

Brewer et al. (2010) compared a cohort of 18 community dwelling individuals with SCI and pressure injuries, who were supplemented with 9 g/day powdered arginine, against audits of a matched historical control group. Arginine treatment continued until pressure injuries were healed but it should be noted that the supplemental powder also contained carbohydrates and vitamins C and E, the latter vitamins of which are controversial in their effects over pressure injury healing in other patient populations (Ehrlich et al. 1972; Vilter 1980; Albina 1994; Dorner et al. 2012). However, the authors did take care to exclude participants who presented with other healing comorbidities such as renal insufficiency, metabolic diseases and other co-morbidities. The resulting healing time was significantly improved by half the number of weeks required for healing by the historical controls across all categories of pressure injuries (p<0.006).

Conclusion

There is level 4 evidence (from one pre-post study: Brewer et al. 2010) for arginine supplementation for pressure injury healing.

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