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Clinical Diagram · Surgical Recovery · Wound Healing

The Wound Healing Cascade —
And the Nutrition
Each Phase Needs

Wounds heal in four overlapping stages. Each uses particular nutrients. Select a phase to see what the biology needs and how strong the evidence is. Most of this is lab biology (Mechanistic). Where trials in people exist, the caption says so.

HAEMOSTASIS INFLAMMATION PROLIFERATION REMODELLING 0h 24h 3–4 days 2–3 weeks Weeks–1 year+ Vit K · Protein Vit C · Zinc · Vit D Vit C · Iron · Zinc · Copper · Protein Vit C · Zinc · Protein Click any phase to see the nutrients involved and how strong the evidence is

Timings are approximate and vary with the wound.

Phase 1
Haemostasis
Roughly the first hours
What the biology is doing
Blood vessels tighten, platelets clump and a fibrin clot forms. The clot stops bleeding and becomes the scaffold for repair.
Nutrients involved, and how strong the evidence is
What a shortfall does
In practice
Vitamin K deficiency causes bleeding. Many medicines and supplements affect clotting: tell your surgical team about all of them and follow their instructions on what to stop and when.
Evidence

How strong is the evidence?

The grades on this page: Strong good randomised trials agree. Mixed few, small, short, unblinded or conflicting trials. Observational: a link, not proof of cause. Mechanistic the biology makes sense but hasn’t been shown to change outcomes in people. None no usable evidence. Practice expert, guideline or coaching practice, not trial-tested. Established physiology: textbook biology where the deficiency disease is documented in people (scurvy; vitamin K deficiency bleeding).

ClaimGradeMain source
Wounds heal in four overlapping phasesEstablished physiologyGuo 2010
Vitamin C and vitamin K deficiencies impair healing and clottingEstablished physiology—
Extra vitamin C speeds healing if not deficientMixed not shownter Riet 1995
Extra zinc speeds healingMixed not shownWilkinson 2014
Low vitamin D goes with more surgical-site infectionsObservationalFarsakoury 2026
Copper, omega-3 and CRP effects on healingMechanistic—
Fixed correction times for ferritin, vitamin D, zincNone—
Why this matters clinically

The same biology, whatever the procedure

A hip incision, a knee repair, a tooth socket or a caesarean wound all heal through the same stages.

The pre-operative assessment checks that you’re safe to operate on. NICE recommends a full blood count before major surgery; it doesn’t list iron stores, zinc, vitamin C, vitamin D or CRP among the routine tests (NICE NG45). Low iron stores can be missed when the full blood count looks fine. In anaemic patients, a ferritin of 30 µg/L (30 ng/mL) or less picked out iron deficiency far more reliably than the old cut-off of 12 µg/L (12 ng/mL) (Mast 1998). The British Society of Gastroenterology reads a ferritin below 30 µg/L (30 ng/mL) as low iron stores (BSG 2021). Whether topping up someone who isn’t deficient changes how they heal is mostly untested.

If a test finds a deficiency, treating it can take weeks, and how long depends on the nutrient and the treatment. Testing well before a planned date leaves time to act. Practice Your GP or pre-assessment team will tell you what applies to you.

Sources

  1. Akintoye E et al. Fish oil and perioperative bleeding. Circ Cardiovasc Qual Outcomes 2018;11:e004584. PMID 30571332. doi:10.1161/CIRCOUTCOMES.118.004584
  2. Farsakoury R et al. Vitamin D deficiency and risk of surgical site infections: a systematic review and meta-analysis. Surg Infect (Larchmt) 2026;27:78–84. PMID 41108122. doi:10.1177/10962964251389152
  3. Guo S, DiPietro LA. Factors affecting wound healing. J Dent Res 2010;89:219–29. PMID 20139336. doi:10.1177/0022034509359125
  4. Snook J et al. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut 2021;70(11):2030–51. PMID 34497146. doi:10.1136/gutjnl-2021-325210. Below 15 µg/L: absent iron stores; below 30 µg/L: low iron stores; up to 100 µg/L can still mean iron deficiency in active inflammatory bowel disease.
  5. Mast AE et al. Clinical utility of the soluble transferrin receptor and comparison with serum ferritin in several populations. Clin Chem 1998;44:45–51. PMID 9550557. PubMed
  6. NICE. Routine preoperative tests for elective surgery (NG45). 2016. nice.org.uk
  7. ter Riet G et al. Randomized clinical trial of ascorbic acid in the treatment of pressure ulcers. J Clin Epidemiol 1995;48:1453–60. PMID 8543959. doi:10.1016/0895-4356(95)00053-4
  8. Weimann A et al. ESPEN guideline on clinical nutrition in surgery: update 2025. Clin Nutr 2025;53:222–61. PMID 40957230. doi:10.1016/j.clnu.2025.08.029
  9. Wilkinson EAJ. Oral zinc for arterial and venous leg ulcers. Cochrane Database Syst Rev 2014;(9):CD001273. PMID 25202988. doi:10.1002/14651858.CD001273.pub3

I sell testing and consultations, including a pre-surgical assessment, so I declare an interest: the grades on this page apply to them too.

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