The Role of Vitamin D in Plastic and Reconstructive Surgery: A Systematic Review of Human and Animal Studies

Vitamin D, a fat-soluble hormone, is increasingly recognized for its critical roles in immunomodulation, inflammation control, and tissue regeneration. Its deficiency is a global public health concern, affecting postoperative outcomes across various surgical fields, including plastic and reconstructive surgery.

To systematically review the existing literature on the impact of preoperative and perioperative vitamin D levels on surgical outcomes in plastic and reconstructive surgery, combining findings from both animal and human studies.

A detailed literature search was conducted in Embase, PubMed, Ovid Medline, PubMed Central, Scopus, and Cochrane Central databases. Inclusion criteria encompassed human and animal studies examining the role of vitamin D in wound healing, aesthetic procedures, reconstructive surgeries, nerve regeneration, and orthognathic interventions. Data extraction and quality assessment were performed using standardized tools. A structured sensitivity analysis by study design and quality was also performed.

Fifteen studies met the inclusion criteria, including 11 human studies and 4 animal studies. Lower preoperative vitamin D levels were consistently associated with poorer wound healing outcomes, such as hypertrophic scarring, keloid formation, and complication rates in aesthetic and reconstructive surgeries. Animal studies demonstrated that vitamin D supplementation improved flap survival by enhancing angiogenesis and reducing inflammation. Preclinical studies and case reports highlighted vitamin D's neuroregenerative benefits and its role in maintaining bone integrity in orthognathic surgeries. Conclusions regarding wound healing, scarring, and bone healing remained robust across exclusion scenarios. Findings related to nerve regeneration depended predominantly on preclinical evidence.

Vitamin D emerges as a potential biomarker and therapeutic agent that could improve surgical outcomes in plastic and reconstructive surgery. Despite promising findings, current evidence faces limitations, including small sample sizes, heterogeneous populations, and inconsistent vitamin D measurement methods. Future large-scale, high-quality studies are necessary to establish definitive guidelines for vitamin D assessment and supplementation in surgical care.