Impact of Local Insulin Injection on Split Thickness Skin Graft Donor Site Healing

Abstract

Background: Split thickness skin graft (STSG) remains the most common surgical technique to cover skin defects. However, the healing of its donor area is of paramount importance. Multiple local drugs are frequently used to enhance its epithelialization. Systemic Insulin was proved to be beneficial for chronic wound healing such as pressure sores and diabetic ulcers. But the impact of local insulin injection was scarcely studied before as regard wound healing.Objectives: This study aimed to evaluate the effect of intradermal insulin injection on the donor of harvested split thickness skin graft (STSG).Patients and Methods: In this study, 40 patients; 18 males and 22 females with skin loss planned to be covered by STSG were selected. Pregnant, lactating, pre-diabetics and diabetic patients were excluded. The dimensions of the raw area ranged from 5-10cm for maximum height and width. The thigh was used as a donor area and divided by a horizontal line into test (upper proximal half) and control (lower distal half) areas. Then, a 10 IU of long-acting insulin (Lantus ®) was intradermally injected in the test area. Random blood sugar was measured 6 hours postoperatively. The rate of epithelialization on days 14 and 21 was analyzed by a special software (Image J®) and the scar quality was also evaluated by Vancouver scar scale (VSS).Results: For the test area, the rate of epithelialization was significantly faster on days 14 and 21 as compared with the control area. But there was no statistical difference between both areas regarding the scar quality when using Vancouver scar scale. Conclusion:Intradermal injection of insulin in donor sites of split thickness skin graft accelerates its healing which allows early re-harvesting of grafts from same donor sites.