The effect of local insulin injection on the healing process of split thickness skin graft donor site: a randomized, dou
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ORIGINAL PAPER
The effect of local insulin injection on the healing process of split thickness skin graft donor site: a randomized, double-blind, placebo control clinical trial Shahriar Haddady Abianeh 1 & Sohrab Moradi Bajestani 1 Nooshin Shirzad 3
&
Javad Rahmati 1 & Mohammad Amin Shahrbaf 2 &
Received: 17 October 2019 / Accepted: 22 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Wound site coverage by a split-thickness skin graft (STSG) is an effective technique after reconstructive surgery. Previous studies have been suggested that insulin is a stimulator for skin wound healing. This study was aimed to determine the effect of local insulin injection on the improvement of STSG donor site wound healing. Methods A randomized clinical trial was performed in patients undergoing STSG in 2019. The donor site of patients was divided into control and case segments. Two cubic centimeters of NPH insulin was injected at the case segment with a concentration of 1 IU/ml and normal saline was injected at the control segment by the same volume. The wound site epithelialization area was calculated by ImageJ® software at the 7th, 14th, and the 21st day after the intervention. The epithelialization area of the case and control group was compared by SPSS software. Results Epithelialization area was improved at the 21st day compared to 14th day and 7th day. In addition, the amount of epithelialization was significantly higher at the case segment in the 7th, 14th, and the 21st day after the injection with the P values of 0.006, 0.001, and < 0.0001, respectively. Moreover, there was not any sign of hypoglycemia and other complications in patients. Conclusion Subdermal injection of insulin may improve the wound site epithelialization in the post-operative period. Level of evidence: Level I, therapeutic study. Keywords Insulin . Wound . Reconstructive surgery . Healing
Introduction Reconstruction of defective tissues which are injured by trauma, tumor, and congenital anomalies is one of the major concerns in reconstructive surgery [1]. Split thickness skin graft (STSG) is a common practice in plastic surgery which is used * Sohrab Moradi Bajestani [email protected] 1
Department of Plastic and Reconstructive Surgery, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
2
Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3
Department of Plastic and Reconstructive Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
for the rapid coverage of skin lesions caused by injuries [2]. The average time of the wound healing at the donor site of the STSG is 12 to 14 days. However, increasing the quality and rate of STSG donor site wound healing shortens recovery time [3]. Cutaneous wound repair is a dynamic process that consists of inflammation, oxidative stress, cell migration, and cell proliferation [4, 5]. Proteins such as fibrin and collagen in addition to the chemical factors such as adipose tissue
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