An investigation into the efficacy of single low dose of insulin in the prevention of excessive cutaneous scarring in breast surgery

Early human fetuses have the ability to heal wounds by completely regenerating tissues, leaving no evidence of scarring. However in the adult scarring is the inevitable endpoint of the wound healing process. Sometimes these scars can be pathological in nature causing both functional and aesthetic problems to those affected. Every year millions of people around the globe acquire problematic or pathological scars either whilst undergoing surgery or from traumatic injuries and at present there remain a severely limited number of pharmacological treatment options to offer these patients. Importantly currently there exists no treatment that can either eliminate or reliably reduce acquired scars. Not only is the treatment of acquired scars problematic but also the clinical assessment of scars is largely subjective in nature and frequently relies on assessment scales that show large amounts of inter-rater variation and lack quantification. Especially subjective is the measurement of scar colour, which can be markedly different from the surrounding skin and cause significant distress to the patient. Without an objective assessment framework clinicians cannot reliably examine scars nor gauge responses to any treatment. The aim of this thesis is thus two-fold. Firstly a new anti-scarring treatment in the form of insulin will be tested in a randomised, double blind, intra-patient, placebo controlled trial where patients undergoing elective bilateral breast surgery will have low-dose insulin injected subcutaneously to one breast and placebo to the other at the time of surgery. Patients will be followed up for 12 months and their scars compared to examine the therapeutic effect of insulin upon scars. Secondly the thesis aims to test the validity of new methods of assessing the scar colour of a subset of patients within the insulin trial using previously untested photographic devices and software. These devices are hoped to add much needed quantification to scar assessment.Open Acces