Edinburgh, East Grinstead, Bath, Bristol, and London, United Kingdom.
From the Department of Plastic Surgery, St John's Hospital; the Department of Plastic Surgery, Queen Victoria Hospital; the Department of Statistics, University of Bath; the Restore Burns and Research Foundation; and The London Clinic.
Plast Reconstr Surg. 2018 Apr;141(4):476e-485e. doi: 10.1097/PRS.0000000000004199.
The role of insulin in expediting wound healing is firmly established within the context of major trauma and burns; however, only limited clinical evidence exists as to its effects on scar formation. This study aims to build on previous laboratory work to examine the potential antiscarring properties of insulin in a clinical environment.
Ninety-one patients undergoing bilateral aesthetic breast operations were recruited to receive low-dose insulin and placebo injections to the medial 3 cm of their submammary incisions within the context of a randomized, intrapatient, placebo-controlled trial, and scar quality was assessed at 3-, 6-, and 12-month reviews using the Manchester Scar Scale.
Across the cohort at 12-month review, the insulin-treated scars had lower scar scores (p = 0.055) compared with placebo. Subgroup analysis of individuals with heavier scars showed that median scar scores were significantly lower for the insulin-treated scars with regard to both scar contour (p = 0.048) and scar distortion (p = 0.045).
Subcutaneous insulin injections reduced the appearance of scarring in this study compared with placebo. The greatest effect was seen in those participants who showed heavier scars and, as such, insulin has a role as an antiscarring therapy in individuals likely to be affected by heavier scarring. Further research is required to more precisely delineate which subjects may benefit most from this treatment.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
胰岛素在促进创伤和烧伤愈合方面的作用已得到充分证实；然而，关于其对瘢痕形成影响的临床证据有限。本研究旨在在前实验室工作的基础上，在临床环境中研究胰岛素的潜在抗瘢痕形成特性。
招募了 91 名接受双侧美容乳房手术的患者，在一项随机、患者内、安慰剂对照试验中，将低剂量胰岛素和安慰剂注射到其乳房下切口内侧 3cm 处，并在 3、6 和 12 个月时使用曼彻斯特瘢痕量表评估瘢痕质量。
在 12 个月的随访中，与安慰剂组相比，胰岛素治疗组的瘢痕评分较低（p=0.055）。对瘢痕较重的患者进行亚组分析显示，胰岛素治疗组的瘢痕轮廓（p=0.048）和瘢痕扭曲（p=0.045）的瘢痕评分中位数明显较低。
与安慰剂相比，皮下注射胰岛素可减少本研究中瘢痕的出现。在那些瘢痕较重的参与者中，这种效果最为显著，因此，胰岛素在可能受较重瘢痕影响的个体中具有抗瘢痕形成作用。需要进一步研究以更精确地确定哪些患者可能从这种治疗中获益最多。
临床问题/证据水平：治疗性，II 级。
