الفهرس 
introduction
physiology of cutaneous wound healingOnly 14 pages are availabe for public view
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Abstract
The principal function of human skin is to protect the body from external environment and so it is important that any damage of it is rapidly repaired through cutaneous wound healing process. Conditions of impaired wound healing (such as chronic wounds or ulcers) are associated with substantial morbidity and mortality, and impose financial burden upon the world’s health services. Therefore, finding agents that accelerate wound healing is mandatory.
A review of the physiological properties of insulin suggests it might favorably influence wound healing because it can stimulate growth of individual cells as well as cause increased anabolism of the organism as a whole.
Preclinical and clinical studies have demonstrated positive effects of insulin on wound healing; these studies were done in laboratories, on experimental animals, and on humans, and revealed acceleration of healing with insulin use.
Zinc is an essential trace mineral for human development and function. Many of zinc-dependent processes are required for wound healing, such as collagen synthesis, epithelialization and cell division. Consequently, zinc is an essential nutrient for normal wound healing.
Zinc is used to crystallize insulin for regular insulin type (short acting).When wounds are treated with regular insulin; they are therefore also being treated with zinc. If Regular insulin accelerates wound healing, it is not clear if the increase in the rate of healing would be due to insulin (a known growth factor), the zinc it contains, or a combination of the two. Therefore, in this study we aimed to evaluate the effect of using regular crystalline insulin containing zinc topically versus zinc solution on healing of uncomplicated acute and chronic wounds in non diabetic humans. We enrolled 90 consecutive patients (41 males and 49 females) with skin wounds in this randomized placebo-controlled clinical trial. Patients were randomly assigned to one of three groups (I, II and III); group I received twice daily regular insulin dressings, group II received sterile aqueous zinc chloride (ZnCl2) solution twice daily and group III received sterile 0.9% saline (0.9% NaCl), twice daily as a placebo (control group).
In general, we found the use of either topical crystalline regular insulin (containing zinc) or topical aqueous zinc on both acute and chronic wounds are safe and effective. It was found
Summary and Conclusion
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that each of topical application of either crystalline regular insulin and aqueous zinc solution enhanced wound healing by shortening the time needed for complete epithelialization of wounds compared to the control group. However, wound healing rates were significantly higher in group I (using topical insulin-zinc) than in group II (using only topical zinc solution with same concentration as that in insulin used by group I). Comparing patients with acute and chronic wounds in each group and among the three studied groups, it was found that the rate of healing showed statistically significant difference being higher in acute wounds. We found the rate of healing of wounds in those ≤ 40 years to be statistically significantly higher than that of those >40 years. Comparing lower body and upper body wounds in our study, the rate of healing of wounds in upper body was statistically significantly higher than lower body wounds. A positive correlation was found between the duration of healing in days and wound area in the three studied groups. After controlling for the effect of area, there was excellent negative correlation between the rate of healing and duration of healing in days for all study groups; i.e. the faster the rate was, the lesser the duration.
We were the first to undergo a questionnaire to determine the effect of wounds on the quality of life. Comparing before and after scores, there was a significant improvement for all questions in the 3 groups (improved physical functioning, improved role limitations due to physical health, improved role limitations due to emotional problems, wound status improvement, improved social functioning, less pain, and better general health), which means enhanced quality of life after healing. Moreover, improvement of all the studied parameters of the questionnaire was directly correlated with the rate of wound healing, particularly pain and general health improvement.