Effects of insulin on wound healing.
BACKGROUND
Insulin plus glucose, given for 7 days to hypermetabolic burn patients, has been shown to stimulate limb protein anabolism. We hypothesized that insulin plus glucose given to burn patients would also stimulate wound healing.


METHODS
Six patients with burns >40% total body surface area were randomized to receive insulin or placebo in a crossover study during the healing of their first and second donor sites. Insulin treatment was titrated at 25 to 49 U/h to achieve a plasma insulin level of 400 to 900 microU/mL for 7 days. Patients receiving insulin received dextrose 50 at 20 to 50 mL/h, titrated to maintain euglycemia. Donor-site biopsies were taken at 7 days and evaluated by three observers blinded to the treatment.


RESULTS
The mean (+/-SD) donor-site healing time was reduced from 6.5 +/- 1.0 days with placebo to 4.7 +/- 1.2 days during insulin infusion (p < 0.05). Laminin showed intense staining along the basal lamina and blood vessels. Collagen type IV staining also increased after insulin therapy compared with placebo.


CONCLUSIONS
Data indicate that high doses of insulin and glucose can be safely administered to massively burned patients to improve wound matrix formation.
Pierre
E J
EJ
Department of Surgery, University of Texas Medical Branch, and the Shriners Burns Institute, Galveston 77550, USA.
Barrow
R E
RE
Hawkins
H K
HK
Nguyen
T T
TT
Sakurai
Y
Y
Desai
M
M
Wolfe
R R
RR
Herndon
D N
DN
D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D002056:Burns / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D018592:Cross-Over Studies; D004359:Drug Therapy, Combination; D005260:Female; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007328:Insulin / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D014945:Wound Healing / Q000187:drug effects*
D001786:Blood Glucose; D007328:Insulin; D005947:Glucose