2026 Clinician Corner - The role of nutritional support in wound healing in low- and middle-income countries

Abstract 

Burn injuries impose a significant global health burden, particularly in low- and middle-income countries where access to surgical interventions is limited. In such settings, supportive measures, especially nutrition, play a central role in recovery. We report the case of a 30-year-old man with ~70% total body surface area scald burns, including superficial and deep partial-thickness injuries. On admission, he was hemodynamically stable but at high risk of malnutrition. Multidisciplinary care included fluid resuscitation, antimicrobial dressings, antibiotics, and early nutrition. Energy and protein goals were set at 3400 to 3800 kcal/day and 153 to 212 g/day, respectively. By day 4, oral intake achieved ~3500 to 3700 kcal/day and 178 to 205 g protein/day. The patient showed rapid healing of superficial burns (50%–55% total body surface area by postburn day 19) and complete wound closure at 5 months, without grafting. One-year follow-up revealed no major complications, although expected scarring and contractures occurred. In conclusion, aggressive nutritional care potentially achieved favorable outcomes in this burn patient. 

Keywords:  burns; clinical nutrition; intensive care unit; minerals; vitamins 

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Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on May 1, 2027.

Learning Objectives

After completing the article, the learner should be able to:

  • Implement early nutritional support strategies tailored to the hypermetabolic needs of burn patients to optimize wound healing and recovery in resource-limited settings. 

  • Identify the critical role of multidisciplinary care, including infection control and family engagement, in managing extensive burns without surgical intervention. 

  • Describe the role of intralesional corticosteroids and fractional CO2 laser therapy in the management of keloid scars, particularly in patients with skin of color. 

  • Identify strategies to minimize the risk of postinflammatory hyperpigmentation complications when using fractional CO2 laser therapy in patients with skin of color. 

Key Points 

  • Early nutritional support (3500–3700 kcal/day, 178–205 g protein) accelerated 50% to 55% total body surface area wound closure by postburn day 19 in a 30-year-old man. 

  • Personalized nutrition prevented severe malnutrition, supporting spontaneous healing of deep partial-thickness burns by 5 months. 

  • A protein intake of 1.8 to 2.5 g/kg is safe for burn patients and does not have hepatic or renal consequences.

  • Keloids are more prevalent and treatment resistant in patients with skin of color. 

  • Disparities in laser access for skin of color populations may reflect cost barriers, training gaps, and limited representation in clinical trials. 

  • Concerns about postinflammatory hyperpigmentation should be weighed against clinical benefit. 

  • Fractional CO₂ laser therapy, when used conservatively, can safely improve keloid appearance and symptoms in Fitzpatrick IV–VI skin. 

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Course summary
Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
05/01/2026
Course expires: 
05/01/2027
Cost:
$25.00

Mohammad Reza Shadmand Foumani Moghadam, BSc, RDN1, Asie Araste, MSc, RDN 2, Mohammad Vejdani, MD,3 and Hossein Safari, MD3 

 

  1. Department of Clinical Nutrition, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran 

  1. Department of Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran 

  1. Department of Burns and Reconstructive Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran  

 

Corresponding author: Mohammad Reza Shadmand Foumani Moghadam, BSc, RDN, RA, Service of Clinical Nutrition and Dietitian, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran 9196773117 (e-mail: [email protected]. 

The planners and faculty for this activity have no relevant financial relationships to disclose. The authors report no funding. The patient consented to publication of this case report. 

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABS CC

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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