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 [micro sign]U/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.
Conclusion: Data indicate that high doses of insulin and glucose can be safely administered to massively burned patients to improve wound matrix formation.
From the Department of Surgery, University of Texas Medical Branch, and the Shriners Burns Institute, Galveston Unit, Galveston, Texas.
Address for reprints: Robert E. Barrow, PhD, Shriners Burns Institute, Galveston, and Department of Surgery at the University of Texas Medical Branch, 815 Market Street, Galveston, TX 77550.