EFFECTS OF INSULIN ON WOUND-HEALING

Background: Insulin plus glucose, given for 7 days to hypermetabolic b urn patients, has been shown to stimulate limb protein anabolism. We h ypothesized that insulin plus glucose given to burn patients would als o 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 sit es. Insulin treatment was titrated at 25 to 49 U/h to achieve a plasma insulin level of 400 to 900 mu U/mL for 7 days, Patients receiving in sulin received dextrose 50 at 20 to 50 mL/h, titrated to maintain eugl ycemia, Donor-site biopsies were taken at 7 days and evaluated by thre e 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 int ense staining along the basal lamina and blood vessels, Collagen type IV staining also increased after insulin therapy compared with placebo . Conclusion: Data indicate that high doses of insulin and glucose can be safely administered to massively burned patients to improve wound matrix formation.