Archives of Critical Care Medicine

Background: Pressure ulcers are skin lesions at bony prominences that develop due to direct pressure on soft tissue. They occur more frequently in paraplegic patients and elderly who are taken care at nursing homes. Nevertheless, patients who underwent major surgeries such as heart and lung operation with prolonged operation and postoperation period are also susceptible to develop soars. These ulcers lead to increased hospitalization rate and high healthcare costs. Because insulin exerts some of its effects through insulin-like growth factor, insulin would be effective on wound healing process.
Objectives: Our aim is to evaluate the effect of topical insulin on healing of pressure sores.
Patients and Methods: This double-blinded clinical trial was conducted on patients with pressure ulcer in Shahid Modarres Hospital,
Tehran, Patients were randomly allocated to two groups. One of these groups was treated with normal saline and the other group by insulin solution (1 U/mL) and after 14 days, wounds were evaluated for size reduction (mm2) and presence of granulation tissue.
Results: A total of 44 patients, with female to male ratio of 1:1 and mean age of 61.84 (12.63) years, participated in the study; 20 patients (45.5%) had hemoglobin level of < 12 mg/dL and 22 patient (50%) had diabetes (Fasting blood glucose > 6.99 mmol/L). Mean size of sore
before and after intervention was respectively 532.27 (390.3) mm2 and 397 (362.5) mm2 with significant reduction in size. However, the changes in sore size before and after intervention between two groups showed no significant difference. In addition, the difference was not significant between patients with and without diabetes. Anemia did not have any effect on wound healing.
Conclusions: Although reduction in wound size was slightly better with insulin dressing than with normal saline (10% vs. 8.5% of sore surface, respectively) this difference was not statistically significant. There was significant decrease in wound size and presence of  granulation tissue after 14 days in all cases irrespective of used dressing.