Int Wound J. 2026 May;23(5):e70935. doi: 10.1111/iwj.70935.
ABSTRACT
Venous leg ulcers (VLUs) are common, difficult to heal, and prone to recurrence. Malnutrition and impaired nitric-oxide-dependent microcirculation may contribute to recalcitrance. Arginine-enriched oral nutritional supplements (ONS) improve healing in other wound types, but data in VLUs is limited. We conducted a prospective single-arm study evaluating arginine-enriched ONS (L-arginine 4.5 g, vitamins C, E) as an adjunct to evidence-based standard care (compression, debridement, infection control and venotonic/hemorheologic agents). Adults with recalcitrant VLUs received daily ONS for 8 weeks. Primary outcome was change in ulcer area; secondary outcomes included complete healing, adverse events and exploratory correlations. Ten patients with chronic VLUs were enrolled. Median prior duration of conventional therapy before ONS was substantial at 32.5 months. From baseline to week 8, mean ulcer area decreased significantly from 30.5 to 21.4 cm2 (p = 0.024), representing a mean reduction of 32.8% (p = 0.012). Eight patients had reductions in ulcer size, with one patient achieving complete epithelisation. Two patients showed minimal improvement. There were no gastrointestinal side effects reported. Arginine-enriched ONS, when added to compression-centred multimodal care, was associated with clinically and statistically significant reductions in VLU area. Findings support nutritional optimisation-including arginine-enriched ONS-as a pragmatic adjunct for recalcitrant VLUs; larger randomised controlled trials are warranted. Clinical relevance: In malnourished or slow-to-heal VLU patients, a short course of arginine-enriched ONS may accelerate closure and can be delivered alongside routine outpatient wound care and compression.
PMID:42117292 | DOI:10.1111/iwj.70935
