Dr. Juan Carlos Rivera performed a series of trials on various patients with different backgrounds.Below you may find nine cases of patients treated with D.O. therapy. The different stages of the treatment process are shown in the pictures, which subsequently were analyzed in order to demonstrate the evolution of wounds and the healing process over time. The tissue development of Necrosis, Granulation and Fibrin was examined. The changes are clearly visible from image to image and are made more drastically clear by visualization in graphs below each case.

Case 1. Abscess in the plantar region

Case 2. Traumatic ulcer in ankle

Case 3. Venous ulcer

Case 4. Edemas in limbs with ulceration

Case 5. Traumatic amputation of finger pulp

Case 6. Traumatic ulcer in anterior aspect of leg

Case 7. Venous ulcers

Case 8. Traumatic ulcer in lateral aspect of leg

Case 9. Amputation of diabetic foot

The following definitions will help in better understanding the differences in these tissues:

Necrosis: Local tissue death. A dry material of dark color. Devitalized due to the destruction of the cells and the blood vessels. This tissue can not heal or form basis for healing.

Granulation: Fibrous connective tissue that replaces a fibrin cloth during the wound healing. The granular tissue grows from the base of the wound and has the capacity to fill it. It is soft to the touch, humid, has light red or intense pink color and irregular (granular) appearance. The granulation tissue forms the basis on which the epithelization process takes place.

Fibrin:  It can be called fibrin, fibrinoid tissue or sloughs. It is devitalized tissue, clinically similar to fibrin, but in addition to this, its composition also includes collagen, neutrophils, macrophages, bacteria and cells. Depending on the degree of hydration of the wound, the color may vary from whitish and yellow to brown.