Fizyolojik Yara İyileşmesi
Özet
Yara iyileşmesi; doku onarımını ve fonksiyonel özelliklerin yeniden kazanılmasını amaçlayan, iç içe geçmiş aşamalardan oluşan kompleks ve dinamik bir süreçtir. Bu süreç hemostaz ve inflamasyon, proliferasyon ile matürasyon ve remodelling olmak üzere üç ana aşamadan meydana gelir. Yaralanma sonrasında vasküler yapıların zedelenmesiyle başlayan hemostaz evresinde, trombositlerin kümelenmesiyle kanama durdurulur ve geçici bir fibrin tıkaç oluşturulur. Ardından başlayan inflamasyon fazında yaraya sırasıyla nötrofiller, monositler (makrofajlar) ve T lenfositler göç eder. Makrofajlar, fagositoz yapmanın yanı sıra salgıladıkları büyüme faktörleriyle anjiogenesis ve matris birikimini düzenleyen vazgeçilmez hücrelerdir. Proliferasyon aşamasında (4.-12. günler) fibroblastlar, düz kas, endotel ve epitel hücreleri baskındır; bu evrede yeni damar oluşumu (anjiogenez), ekstraselüler matriks sentezi, kolajen üretimi, epitelizasyon ve yara kontraksiyonu gerçekleşir. Son evre olan remodelling fazında ise granülasyon dokusu daha az hücreli skar dokusuna bırakılır; kolajenaz aktivitesiyle fazla kolajen yıkılarak lifler mekanik kuvvetlerin etkisiyle düzenli bir hale getirilir. İyileşme tipleri ise primer, sekonder ve tersiyer olarak üç gruba ayrılmaktadır.
Wound healing is a complex and dynamic process consisting of intertwined phases aimed at tissue repair and recovering functional properties. This process comprises three main stages: hemostasis and inflammation, proliferation, and maturation and remodelling. During the hemostasis phase, which begins with the injury of vascular structures after wounding, bleeding is stopped through platelet aggregation, and a temporary fibrin plug is formed. In the subsequent inflammation phase, neutrophils, monocytes (macrophages), and T lymphocytes migrate to the wound site respectively. Macrophages are indispensable cells that perform phagocytosis and regulate angiogenesis and matrix accumulation through the growth factors they secrete. In the proliferation phase (days 4-12), fibroblasts, smooth muscle, endothelial, and epithelial cells are dominant; angiogenesis, extracellular matrix synthesis, collagen production, epithelialization, and wound contraction occur during this stage. In the final phase, the remodelling stage, granulation tissue is replaced by a less cellular scar tissue; excess collagen is degraded by collagenase activity, and fibers are organized regularly under the influence of mechanical forces. Healing types are classified into three groups as primary, secondary, and tertiary healing.
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