Role of topical use of insulin in healing of chronic ulcer

Abstract

Background : Chronic wounds, especially non-healing types, are one of the most common surgical conditions a surgeon comes across. The peculiarity of a chronic wound is that, whatever management you give, they refuse to heal, especially the pressure ulcers or bed sores. Many therapeutic methods are available to effect wound healing such as topical application of insulin, growth factors, negative pressure-assisted wound closure, oxidized regenerated cellulose/collagen, hyaluronic acid conjugated with glycidyl methacrylate or gelatin dressings. A less clinically and economically complicated approach to healing chronic wounds seems necessary. Objectives: To study the efficacy of topical use of insulin in wound healing in following terms:-(1) rate of wound healing; (2) safety evaluation; (3) hospital stay. Materials and Methods: This was a prospective study carried out in a tertiary health centre from July 2010 to September 2012 in 50 patients after taking an informed and written consent of the patients having chronic ulcer. All the patients who were satisfying inclusion/exclusion criteria patient were randomized into two groups, Group A and Group B. Each group was again sub-divided into 1 and 2 i.e. sub-group A1, A2 and sub-group B1, B2. Patients with diabetes were grouped as A1 and B1 and non-diabetic patients were grouped as A2 and B2. Group A patients were treated with insulin dressings and Group B patient's ulcers were treated with normal saline dressings. Ulcer size and healing was recorded on weekly basis. Strict glycemic control was maintained in all diabetic patients. Results were compared at complete healing or at the end of 12 weeks which ever was earlier. Results: Our study included both diabetic and non-diabetic patients. There was no significant change in BSL(R) values after use of insulin on wounds. The number of days required for wound healing in Group A patients in both subgroups (A1 and A2) was significantly less as compared to Group B (B1 and B2). The mean rate of healing of wounds was much faster in Group A as compared to Group B. The hospital stay in Group A patients was significantly less than Group B. Conclusion: The use of topical Insulin strongly suggests accelerated wound healing in chronic ulcer. Topical insulin in chronic ulcer is safe and effective without any systemic side effect. Topical insulin significantly reduces the hospital stay of patients with chronic ulcers. Early return to work decreased economical load.