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Background: After major burns, patients exhibit an intense catabolism, and the wounds require surgery and grafting for closure. Complications, such as weight loss and delayed wound healing, are worsened by trace element (TE) deficiencies. Objective: We aimed to assess the effects of TE supplements on systemic substrate turnover and local protein metabolism during wound healing after major burns. Design: This was a prospective, randomized, placebo-controlled trial in 21 patients aged 35 [+ or -] 11 y with burns on 45 [+ or -] 16% of their body surface area; 12 had skin biopsies performed on days 3, 10, and 20, and 10 patients underwent a stable-isotope investigation on day 10. Intravenous copper, selenium, and zinc (TE group) or vehicle (V group) was given with a saline solution for 14-21 d. On day 10, [[sup.13]C]phenylalanine (600-[micro]g/kg bolus followed by 12 [micro]g * [kg.sup.-1] * [min.sup.-1]) plus 6-[[sup.2] [H.sub.2]]glucose and [sup.2][H.sub.5]]glycerol were infused for 6 h to determine skin protein turnover. Biopsies were performed 1 and 6 h after the start of infusion to determine [[sup.13]C]phenylalanine enrichment. Results: The patients' mean age and burn severity did not differ significantly between the groups nor between the skin investigations subgroups. Plasma TE concentrations were significantly higher in the TE group. In the burned areas, the skin contents of selenium (P = 0.02) and zinc (P = 0.03) increased by day 20. The supernatant-to-plasma [sup.13]C enrichment ratio in burned skin was 0.363 [+ or -] 0.094 (TE group) and 0.286 [+ or -] 0.130 (V group) after 1 h (NS) and 0.592 [+ or -] 0.153 (TE group) and 0.262 [+ or -] 0.171 (V group) after 6 h, which reflected lower catabolism in the TE group (P = 0.03). No significant differences in whole-body substrate turnover were found between the groups. Conclusion: TE supplementation was associated with an increased skin tissue content of selenium and zinc and with a reduction in skin protein catabolism. KEY WORDS Critical illness, burns, supplementation, protein turnover, wound healing, trace elements

Background: After major burns, patients can develop nutritional deficiencies including trace element (TE) deficiencies. Various complications, such as infections and delayed wound healing, influence the clinical course of such patients. Objectives: We aimed to investigate the effects of large, intravenous doses of TE supplements on circulating and cutaneous TE tissue concentrations, on antioxidant status, and on clinical outcome after major burns. Design: This was a prospective, randomized, placebo-controlled trial in 21 patients aged 35 [+ or -] 11 y ([bar.x] [+ or -] SD) with burns on 45 [+ or -] 21% of their body surface area. Intravenous copper, selenium, and zinc (TE group) or vehicle (V group) was given with a saline solution for 14-21 d. Blood and urine samples were collected until day 20, and skin biopsy specimens were collected on days 3, 10, and 20. Results: The age of the patients and the severity of their burns did not differ significantly between the groups. Plasma TE concentrations were significantly higher in the TE group. In burned areas, skin contents of both selenium (P = 0.05) and zinc (P = 0.04) increased significantly by day 20. Plasma and tissue antioxidant status was improved by supplementation. The number of infections in the first 30 d was significantly lower in the TE group (P = 0.015), with a median number of 2 versus 4 infections per patient in the TE and V groups, respectively, as a result of a reduction in pulmonary infections (P = 0.03). Wound healing was improved in the TE group, with lower requirements for regrafting (P = 0.02). Conclusions: TE supplementation was associated with higher circulating plasma and skin tissue contents of selenium and zinc and improved antioxidant status. These changes were associated with improved clinical outcome, including fewer pulmonary infections and better wound healing. KEY WORDS Critical illness, burns, supplementation, infection, deficiency, requirements, trace elements