WOUND HEALING
which started in the wound;
cell proliferation
cell movement
Collagen synthesis
Collagen cross-link formation
It is a harmonious process of cellular biochemical dynamic events intertwined in shape.
Its main element is cell reproduction.
Complex dynamic, biochemical chain of cytological events with chronic inflammation as the main pathogenesis.
There are three main phases intertwined,
Phase 1: Inflammatory phase (exudation, substrate phase)
Phase 2: Proliferation phase (collagen production)
3. Phase: Maturation phase
INFLAMMATORY PHASE
Blood fills the wound area.
– Fibrinogen turns into fibrin and a clot is formed, which has a covering function on the wound.
– As the clot retracts, it brings the wound lips closer together and dries up and cuts off the wound’s relationship with the external environment.
-Inflammation is initiated by increasing capillary permeability.
Within 12-24 hours, leukocytes, especially neutrophils, migrate to the wound.
Reactive oxygen species are released from activated neutrophils and lead to lipid peroxidation.
Then lymphocytes and macrophages come and proteases, vasoactive peptides, growth and chemotactic factors are released.
-Macrophages try to save the wound from pathogenic micro-organisms, tissue residues and depleted neutrophils.
– Fibroblast and endophel cells proliferate. Fibronectin and hyaluronic acid are deposited.
-Fibrinolysis is activated.
– New vessel formation is activated in the hypoxic environment in the wound center.
-Hyperemia, edema, and temperature increase are dominant in the wound area.
PROLIFERATION PHASE
-Reperation period starts in 3-5 days and lasts for 15-21 days.
-Young fibroblasts release EGF and KGF.
-Collagen, elastin, fibronecter proteans are released.
-The skin fibroblasts and the mesenchymal cells around the vessels transform into myoblasts.
A rapid increase in the tensile strength of the wound begins.
– Collagen synthesis and angiogenesis dominate.
MATURATION PHASE
-Remodeling maturation period.
-Cellular elements are reduced.
– Collagen production – destruction balance is in question
-The collagen roof gains strength and maturation is completed in 6-12 months.
-Hardness and edema disappear, the pinkness disappears and becomes pale.
GENERAL PROBLEMS IN DIABETIC FEET
– Impaired production of growth factors
-There is a problem in angiogenesis
-Macrophage functions are impaired
– Disruption in collagen synthesis
– Impairment of epidermal barrier function
– Disruption in the formation of granulation tissue
– Impairment of keratinocyte and fibroblast migration and proliferation
– Deterioration of oxygen and nutrient (mineral, vitamin) distribution in tissues.
– Impairment in the elimination of metabolic wastes in the tissue
-Latent acidosis
– Problems in intracellular organelles, membrane, basic matrix, etc.
(+) Findings in the Anamnesis:
BASE
55y.
Mom
85y.
– DM(+)
– Heart Disease (+)
Father
ex
– DM(+)
– Coronary Vascular Disease (+)
Patient
DM(+) – Cardiac By Pass (+) 2019
Coraspin tb. – Diamicron tb. – Concor tb. – Tarden tb. (stop)
-1 year smoking (+)
-6 months of continuous antibiotics (+) (stop)
-Partial Paralysis (+)
-Father’s Death 2003 – Chronic Stress, Depression, Anxiety
-Weakness, Chronic Fatigue, Insomnia, Nausea, Anorexia, Nausea, Constipation (1 per week)
-Inability to walk, Fever, Fear, Inability to eat, Morning Fatigue, Inability to focus
-Nutrition with more Meat and Dairy Products. Daily Water Consumption: 1 lt.
– Shortness of breath, feeling unwell
-Forgetfulness
FM(+) Findings
-Dyspnea
-Acidosis – Evidence of Acidosis on the Skin
-Skin Dry, Rash
-Turgor Tone decreased
-Stressed and Fear (+)
-In the USG taken outside
-stone in SK
-Renal Cyst
– Fat in the liver
-Blood Sugar 230 mg/dl urine pH=5.5
-CRP=50
-Incision Squeezers available
-Wound on both feet
-lt Extremity Pulses are weak
-West defense (+) rest (+)
-Right foot 4. Toe amputated
-Necrosis in the 5th toe of the right foot
-Partial necrosis of the 2nd toe of the right foot
-Infection in the 3rd toe of the right foot
-Surgery-related osseous structures were removed.
-Weakening of lower extremity pulses
What do the Anamnesis and FM Findings show? Let’s see…
A. Sleep Disorder
Phase I Detox Disorder and Acidosis
b.
Constipation
Chronic Inflammation
acidosis
Gallstone
Fatty Liver
Leaky Gut?
-> Phase II Detox Disorder
C.
Chronic Fatigue
dyspnea
No Sweating
Hyperemic Skin
Dehydrated and Rash Skin
Decrease in Turgor Tonus
Redness when skin is touched on FM
-> Acidosis
D.
Anorexia
Skin Rashes
Chronic Fatigue
Difficulty Focusing
DM (+)
atherosclerosis
Diabetes-related problems
Hemiplegia
Cardiac By Pass
-> Chronic Inflammation
TO.
Weakness
Lack of Energy
Constipation
Anorexia
Loss of Hunger
DM (+)
atherosclerosis
Chronic Fatigue
acidosis
dyspnea
Hemiplegia
-> Mitochondrial Dysfunction
f.
Weakness
Chronic Fatigue
Forgetfulness, Insomnia
DM (+)
Not Feeling Well
->Chronic Toxicity
g.
atherosclerosis
Instability in Blood Pressure
Weak Pulses
Thrombosis
embolism
stenosis
Hemiplegia
-> Vascular Endothelial Degeneration
FREE FOOD GROUPS IN THE ELIMINATION DIET
-Vegetables and fruits (prefer organic ones whenever possible)
– Vegetable milks (Almond milk, coconut milk, organic soy milk, etc.)
-Rice (if possible basmati, jasmine, brown rice etc.)
– Legumes (Dried beans, chickpeas, lentils, etc.)
– Unroasted raw nuts free (Walnut, Almond, Hazelnut)
– Seeds such as pumpkin seeds, sunflower seeds
-Small animal meat (lamb, sheep, goat meat)
-Fish (Seasonal, small sea fish; anchovies, horse mackerel, sardines, etc.)
-Poultry (non-GMO organic chicken, Turkey if available)
-Gluten-free cereals and similar foods (quinoa, buckwheat, teff, amaranth)
-Healthy fats; olive oil, clarified butter (natural butter, separated by heating)
-Spices (turmeric, ginger, thyme, rosemary, cinnamon)
-Green tea free, black tea? (If black tea is consumed too much, its amount should be reduced)
FOOD GROUPS PROHIBITED IN THE ELIMINATION DIET
-All sugar and sweeteners (Fructose syrup-Sucrose-Sugar)
-Gluten grains and their flours (Wheat-Barley-Rye)
-Dairy products (Cheese-Yogurt-Milk)
-Processed Meat Products (Salam-Sausage)
-shellfish
-Sweetcorn
-Beef
-Soy and products containing soy
-Alcohol-Coffee
-Peanut
-Vegetable refined oils (Sunflower-Canola-Corn etc.)
