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Role of the topicaly applied insulin in wound healing

Discussion in 'General Surgery' started by prof-shakeel, Feb 15, 2014.

  1. prof-shakeel

    prof-shakeel Well-Known Member

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    One of the greatest challanges the surgeons are facing at all times is the wound healing. There are a great number of factors that hinder wound healing and m1% techniques are used to get rid of such factors trying to enhance wound healing.

    A great part of my life was dedicated trying to find out all the differet possible methods that could help me in healing my patients wounds.

    It is well known that neutrophils are the mast type closells that are involved in the inflamatory response‚they clean exogenous parhogens through phagocytosis ‚but macrophages also have the function of phagocytosis . It has been noticed that neutrophils are not essential to wound healing‚ since it has been shown that anti-neutrophils antibodies do not interfere with healing. On the contrary‚ depletion of neutrophils facilitates wound healing and improves the quality of recovery. Additionally prolonged neutrophil infiltration may contribute to impaired wound healing. Traumatic release of MIP-2 ( a member of CXC chemokines ) strongly induces neutrophil chemotaxis. But the studies showed that local insulin application restrains the traumatic MPI-2 release significantly and similarly the wound neutrophils also notably decrease.

    These observation suggested that topical insulin regulates the inflamatory response in the wounded area by resrtraining wound neurrophil infiltration through inhibition of MIP-1 expression. Another effect of insulin is that it stabilizes vessel wall so decreases vessel permeability.

    In 1998 and having this conept I started to perform a research work to get the title of Auxiliar Profesor in General Surgery to demonstrate the effect of locally injected insulin in wound healing in vivo.

    Eighty five non-diabetic patients between 15 and 60 of ages were gathered, all of them having different types of wounds of different sizes in different areas of the body. Their wounds were prepared first then I started mycstudy on them.

    Here I am going to disccus only about one patient to whom I did the study. A young 16 years old male patient having a wound due to fire work of 12 cm long and 3 cm apart in the right calf area not curing since 7 years by all classic methods of wound dressing.

    I prepared his wound. At the moment of the study I established an IV line and gave him 20 cc of concentrated glucose solution at 40%, prepared a solution of 1 cc of long acting diluted insulin desolved in 10 cc of normal saline solution at 0. 9 % then injected it in very small well studied and greatly controled amount inside the inner aspect of the wound spreading it evenly. These steps were repeated daily and an amazing result was seen. In about 16 days only the whole wound was strongly closed.
     

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    Last edited: Feb 16, 2014

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