Abnormalities in wound healing US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Abnormalities in wound healing. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Abnormalities in wound healing US Medical PG Question 1: A 62-year-old woman is hospitalized for an open reduction of a fracture of her right femur following a motor vehicle accident 2 hours prior. She has had rheumatoid arthritis for 12 years. She was hospitalized 1 month ago for an exacerbation of rheumatoid arthritis. Since then, she has been taking a higher dose of prednisone to control the flare. Her other medications include calcium supplements, methotrexate, and etanercept. She has had appropriate nutrition over the years with regular follow-ups with her healthcare providers. Her vital signs are within normal limits. Cardiovascular examination shows no abnormalities. In order to reduce the risk of post-operative wound failure, which of the following is the most appropriate modification in this patient’s drug regimen?
- A. Replacing prednisone with hydrocortisone
- B. Applying topical vitamin C
- C. Adding zinc supplementation (Correct Answer)
- D. Discontinuing steroids before surgery
- E. Increasing prednisone dose initially and tapering rapidly after 3 days
Abnormalities in wound healing Explanation: ***Adding zinc supplementation***
- **Zinc** plays a crucial role in **collagen synthesis**, immune function, and **wound healing**, making supplementation beneficial for reducing post-operative wound failure, especially in patients with chronic inflammatory conditions or those on corticosteroids.
- Chronic inflammation from **rheumatoid arthritis** and long-term **corticosteroid use** can impair zinc absorption and lead to deficiency, which exacerbates wound healing issues.
*Replacing prednisone with hydrocortisone*
- Both **prednisone** and **hydrocortisone** are corticosteroids, and switching between them does not inherently reduce the risk of wound failure.
- While prednisone is converted to prednisolone in the liver, hydrocortisone is directly active; both have similar immunosuppressive and anti-inflammatory effects that can impair wound healing.
*Applying topical vitamin C*
- **Topical vitamin C** is primarily used for its antioxidant properties and role in collagen synthesis in the skin, but its systemic effect on deep surgical wound healing is limited.
- **Systemic vitamin C deficiency** can impair wound healing, but the patient's history of appropriate nutrition suggests this is less likely to be the primary issue.
*Discontinuing steroids before surgery*
- Abruptly discontinuing **prednisone**, especially in a patient on a higher dose for an **RA flare**, carries a high risk of causing an **adrenal crisis**, which is life-threatening.
- Steroids are typically continued at a stress-dose equivalent during surgery to prevent **adrenal insufficiency**, not discontinued.
*Increasing prednisone dose initially and tapering rapidly after 3 days*
- Increasing the **prednisone dose** pre-operatively could further suppress the immune system and impair wound healing, increasing the risk of infection and dehiscence.
- While a **stress-dose steroid** regimen is appropriate, the goal is to provide physiological replacement, not to significantly increase the dose beyond what is necessary to prevent adrenal crisis.
Abnormalities in wound healing US Medical PG Question 2: A 55-year-old African American female presents to her breast surgeon for a six-month follow-up visit after undergoing a modified radical mastectomy for invasive ductal carcinoma of the left breast. She reports that she feels well and her pain has been well controlled with ibuprofen. However, she is frustrated that her incisional scar is much larger than she expected. She denies any pain or pruritus associated with the scar. Her past medical history is notable for systemic lupus erythematosus and multiple dermatofibromas on her lower extremities. She has had no other surgeries. She currently takes hydroxychloroquine. On examination, a raised hyperpigmented rubbery scar is noted at the inferior border of the left breast. It appears to have extended beyond the boundaries of the initial incision. Left arm range of motion is limited due to pain at the incisional site. Abnormal deposition of which of the following molecules is most likely responsible for the appearance of this patient’s scar?
- A. Type III collagen
- B. Proteoglycan
- C. Elastin
- D. Type I collagen (Correct Answer)
- E. Type II collagen
Abnormalities in wound healing Explanation: ***Correct: Type I collagen***
- Keloids are characterized by an **overgrowth of dense, disorganized type I collagen fibers** that extend beyond the original wound boundaries. The patient's scar is described as a **"raised, hyperpigmented, rubbery scar" that "extended beyond the boundaries of the initial incision,"** which is characteristic of a keloid.
- Patients with **African American ethnicity**, a history of **dermatofibromas** (which can predispose to keloid formation), and a lack of pain or pruritus are all consistent with a keloid.
- Type I collagen comprises **over 80% of the collagen in mature keloid tissue** and accounts for the characteristic firm, raised appearance.
*Incorrect: Type III collagen*
- **Type III collagen** is prominent during the **initial proliferative phase of wound healing** and is later replaced by type I collagen in mature scars.
- While present early in wound healing, its excessive deposition is not the primary feature of a **mature keloid** that extends beyond the wound margins.
- Normal scars have a type I to type III collagen ratio of approximately 4:1, while keloids have a much higher ratio.
*Incorrect: Proteoglycan*
- **Proteoglycans**, such as decorin and biglycan, are components of the extracellular matrix that play a role in collagen fibril assembly and tissue hydration.
- Although proteoglycans are found in keloids, their **abnormal deposition** is secondary to the extensive collagen formation and not the primary structural molecule responsible for the bulk and characteristic appearance of the scar.
*Incorrect: Elastin*
- **Elastin** provides **elasticity and recoil** to tissues, such as skin, blood vessels, and ligaments.
- Keloids are characterized by **fibrosis and rigidity**, not increased elasticity, and abnormal elastin deposition is not the hallmark of their pathogenesis.
*Incorrect: Type II collagen*
- **Type II collagen** is primarily found in **hyaline cartilage** and vitreous humor, providing resistance to intermittent pressure.
- It is **not a significant component of skin or scar tissue**, making its abnormal deposition irrelevant to the pathogenesis of cutaneous keloids.
Abnormalities in wound healing US Medical PG Question 3: A 48-year-old man is brought to the emergency department with a stab wound to his chest. The wound is treated in the emergency room. Three months later he develops a firm 4 x 3 cm nodular mass with intact epithelium over the site of the chest wound. On local examination, the scar is firm, non-tender, and there is no erythema. The mass is excised and microscopic examination reveals fibroblasts with plentiful collagen. Which of the following processes is most likely related to the series of events mentioned above?
- A. Development of a fibrosarcoma
- B. Foreign body response from suturing
- C. Staphylococcal wound infection
- D. Poor wound healing from diabetes mellitus
- E. Keloid scar formation (Correct Answer)
Abnormalities in wound healing Explanation: ***Keloid scar formation***
- A **keloid** is a raised, firm, nodular scar that extends beyond the original wound boundaries and is characterized by excessive collagen deposition from **fibroblasts**.
- The delayed presentation (3 months), firm nature, absence of inflammation (no erythema, non-tender), and microscopic findings of fibroblasts with plentiful collagen are classic features of a keloid.
*Development of a fibrosarcoma*
- A fibrosarcoma is a **malignant tumor** of fibroblasts, which would typically present with more aggressive growth, often pain, and possibly ulceration, none of which are described.
- While composed of fibroblasts, fibrosarcomas exhibit **cellular atypia**, mitotic activity, and invasion, which are not mentioned in the microscopic description.
*Foreign body response from suturing*
- A foreign body response usually involves a **granulomatous inflammation** around foreign material, such as suture remnants.
- The microscopic description of "fibroblasts with plentiful collagen" without mention of inflammatory cells or foreign bodies makes this less likely.
*Staphylococcal wound infection*
- A **bacterial infection** would typically present with signs of acute inflammation such as erythema, warmth, pain, and possibly pus, shortly after the wound.
- The mass is described as non-tender with no erythema, and the 3-month delay makes an active infection less probable.
*Poor wound healing from diabetes mellitus*
- Poor wound healing in diabetes often manifests as **delayed closure**, chronic ulcers, and increased susceptibility to infection, rather than an overgrowth of fibrous tissue in the form of a nodular mass.
- While diabetes can affect wound healing, the specific description of a firm, nodular mass with excessive collagen points away from typical diabetic wound complications.
Abnormalities in wound healing US Medical PG Question 4: A 35-year-old man is pulled out of a burning building. He is unconscious and severely injured. He is transported to the nearest emergency department. Upon arrival, he is stabilized and evaluated for burns and trauma. Approximately 40% of his body is covered in burns. The burned areas appear blackened and charred but the skin is mostly intact. It is noted that the patient has loss of pain sensation in the burnt areas with minimal blanching on palpation. The affected area is leathery when palpated. What category of burn did the patient most likely to suffer from?
- A. Superficial (1st degree)
- B. Full-thickness (3rd degree) (Correct Answer)
- C. Superficial-partial thickness (2nd degree)
- D. Deep-partial thickness (deep 2nd degree)
- E. Full-thickness with extension to underlying structures (4th degree)
Abnormalities in wound healing Explanation: ***Full-thickness (3rd degree)***
- The description of **blackened, charred appearance**, **loss of pain sensation**, **minimal blanching**, and **leathery texture** are classic signs of a **full-thickness (3rd-degree) burn**.
- **Full-thickness burns** destroy the entire dermis, including nerve endings, leading to a painless area.
- The leathery texture results from protein coagulation in the destroyed dermis.
*Superficial (1st degree)*
- This type of burn affects only the **epidermis**, causing redness, pain, and no blistering.
- The patient's presentation of charred skin and insensitivity to pain is inconsistent with a **superficial burn**.
*Superficial-partial thickness (2nd degree)*
- **Superficial partial-thickness burns** involve the epidermis and superficial dermis, characterized by painful blisters and redness.
- The absence of pain and presence of charred skin rule out this type of burn.
*Deep-partial thickness (deep 2nd degree)*
- **Deep partial-thickness burns** extend into the deep dermis and may have **decreased pain sensation** due to nerve damage.
- However, these burns typically appear **mottled red or white** rather than blackened and charred, and usually have some blanching response.
- The completely charred, blackened appearance with absent pain indicates full-thickness injury.
*Full-thickness with extension to underlying structures (4th degree)*
- A **4th-degree burn** extends beyond the skin into **muscle, bone, or tendons**, often with visible destruction of these structures.
- The affected area would typically be **very firm or hard** with exposed deeper tissues.
- While the burn is severe, the description focuses on skin characteristics without obvious involvement of deeper anatomical structures like muscle or bone.
Abnormalities in wound healing US Medical PG Question 5: A 56-year-old woman undergoes open reduction and internal fixation of the distal tibia 1 day after a fall. She has had rheumatoid arthritis for 12 years and diabetes mellitus for 2 years. Her medications over the past year have included metformin, prednisone, calcium supplements, and methotrexate. Prior to surgery, insulin was added to her medications, and the dose of prednisone was increased. She has had appropriate nutrition over the years with regular follow-ups with her healthcare professional. Which of the following is the most appropriate supplement to prevent wound failure in this patient?
- A. Glutamine
- B. Zinc
- C. Vitamin A
- D. Arginine
- E. Vitamin C (Correct Answer)
Abnormalities in wound healing Explanation: ***Vitamin C***
- This patient is at high risk for **wound healing complications** due to her comorbidities (diabetes, rheumatoid arthritis) and medications (prednisone, methotrexate). **Vitamin C** (ascorbic acid) is essential for **collagen synthesis** and cross-linking, which is crucial for wound strength and tissue repair.
- While other options play a role in wound healing, Vitamin C is particularly important in patients with **impaired healing** due to chronic inflammation, corticosteroid use, and metabolic disorders, as it counteracts their negative effects on collagen formation.
*Glutamine*
- **Glutamine** is an important fuel for rapidly dividing cells, including immune cells and fibroblasts, and can be beneficial in catabolic states.
- However, its role in directly counteracting the specific challenges of this patient's wound healing (corticosteroid use, diabetes, rheumatoid arthritis) is **less direct** compared to Vitamin C's role in collagen synthesis.
*Zinc*
- **Zinc** is a cofactor for numerous enzymes involved in cell proliferation, immune function, and collagen synthesis.
- While important, zinc deficiency is not explicitly indicated, and its role as a primary intervention to prevent wound failure in a patient with **prednisone-induced healing impairment** is secondary to vitamin C.
*Vitamin A*
- **Vitamin A** can help reverse the negative effects of **corticosteroids** on wound healing by promoting epithelialization and collagen synthesis.
- While relevant due to prednisone use, its overall importance in **collagen formation** and direct wound strength is not as profound or broad as Vitamin C.
*Arginine*
- **Arginine** is a precursor for nitric oxide, which improves blood flow to wounds, and is involved in collagen formation and immune function.
- Although beneficial for wound healing, particularly in critically ill patients, it is **not the most appropriate single supplement** for addressing the specific collagen synthesis impairment seen in this patient's context of corticosteroid use and chronic disease.
Abnormalities in wound healing US Medical PG Question 6: A 31-year-old Israeli male with a history of heavy smoking presents to your office with painful ulcerations on his hands and feet. Upon examination, he is found to have hypersensitivity to intradermally injected tobacco extract. Which of the following processes is most likely responsible for his condition?
- A. Eosinophil-rich granulomatous inflammation
- B. Segmental vasculitis of small and medium-sized arteries (Correct Answer)
- C. Increased endothelial permeability
- D. Necrotizing inflammation involving renal arteries
- E. Concentric thickening of the arteriolar wall
Abnormalities in wound healing Explanation: ***Segmental vasculitis of small and medium-sized arteries***
- This presentation is highly characteristic of **Buerger's disease (thromboangiitis obliterans)**, which is a **segmental, inflammatory vasculitis** primarily affecting small and medium-sized arteries and veins of the hands and feet.
- Key features include **painful ulcerations of the hands and feet**, a strong association with **heavy smoking**, and often occurs in young to middle-aged adult males, with a higher prevalence in certain populations (e.g., of Israeli or Asian descent).
*Eosinophil-rich granulomatous inflammation*
- This type of inflammation is characteristic of conditions like **Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis)**.
- Churg-Strauss syndrome typically involves asthma, allergic rhinitis, and eosinophilia, with vasculitis of small to medium vessels, not primarily affecting the distal extremities in this manner or having such a strong tobacco link.
*Increased endothelial permeability*
- While increased endothelial permeability is a feature of general inflammation and can contribute to edema, it is not the primary underlying pathological process causing the **segmental occlusive vasculitis** seen in Buerger's disease.
- This describes a general vascular response rather than a specific disease pathology.
*Necrotizing inflammation involving renal arteries*
- **Necrotizing inflammation of renal arteries** is characteristic of conditions like **polyarteritis nodosa (PAN)** or other systemic vasculitides that can affect renal vessels.
- These conditions typically present with systemic symptoms, hypertension, and renal dysfunction, which are not described in this patient.
*Concentric thickening of the arteriolar wall*
- **Concentric thickening of arteriolar walls** is a hallmark of **hypertensive arteriolosclerosis** or other forms of systemic hypertension.
- This finding would explain chronic end-organ damage from hypertension but does not account for the acute, painful ulcerations in the extremities associated with heavy smoking.
Abnormalities in wound healing US Medical PG Question 7: A 62-year-old man comes to the physician because of a swollen and painful right knee for the last 3 days. He has no history of joint disease. His vital signs are within normal limits. Examination shows erythema and swelling of the right knee, with limited range of motion due to pain. Arthrocentesis of the right knee joint yields 7 mL of cloudy fluid with a leukocyte count of 29,000/mm3 (97% segmented neutrophils). Compensated polarized light microscopy of the aspirate is shown. Which of the following is the most likely underlying mechanism of this patient's knee pain?
- A. Immune complex-mediated cartilage destruction
- B. Calcium pyrophosphate deposition (Correct Answer)
- C. Bacterial infection of the joint
- D. Mechanical stress and trauma
- E. Monosodium urate deposition
Abnormalities in wound healing Explanation: ***Calcium pyrophosphate deposition***
- The **cloudy fluid** with a leukocyte count of **29,000/mm³** predominantly composed of **segmented neutrophils** indicates acute inflammation, characteristic of **pseudogout** (calcium pyrophosphate dihydrate crystal deposition disease).
- **Compensated polarized light microscopy** would reveal **weakly positive birefringent rhomboid-shaped crystals**, confirming CPPD deposition.
- The **age** of the patient (62 years), **acute monoarticular involvement of the knee**, and sudden onset support a diagnosis of **pseudogout**.
*Immune complex-mediated cartilage destruction*
- This mechanism is characteristic of **rheumatoid arthritis** or **systemic lupus erythematosus**, which present with **chronic polyarticular involvement** and systemic features.
- The acute monoarticular presentation and synovial fluid findings are inconsistent with an immune complex-mediated process.
*Bacterial infection of the joint*
- Septic arthritis typically presents with **synovial fluid WBC counts >50,000/mm³** (often >100,000), though some overlap exists.
- The **absence of fever** and presence of **crystal findings on polarized microscopy** distinguish pseudogout from bacterial infection.
- Septic arthritis would not show crystals on microscopy and would require immediate Gram stain and culture.
*Mechanical stress and trauma*
- While mechanical injury can cause joint effusion, the **high neutrophil count** and **acute inflammatory findings** indicate a crystal-induced or infectious arthropathy rather than traumatic injury.
- There is no history of **trauma** reported, and traumatic effusions typically have lower WBC counts with predominantly red blood cells.
*Monosodium urate deposition*
- This indicates **gout**, which presents with **strongly negative birefringent needle-shaped crystals** on polarized microscopy (not the weakly positive birefringent rhomboid crystals of pseudogout).
- Gout more commonly affects the **first metatarsophalangeal joint** and typically occurs in younger patients with hyperuricemia risk factors.
- The patient's age and knee involvement are more consistent with **pseudogout**.
Abnormalities in wound healing US Medical PG Question 8: A 42-year-old man who recently immigrated from Mexico presents to the clinic with fever, a productive cough streaked with blood, back pain, and night sweats. He was found to be HIV-positive 3 years ago but does not know his most recent CD4+ count. With further questioning, the patient notes that he had previously experienced these symptoms when he was in Mexico, but he has no recollection of taking any treatment. Which of the following characteristics would best describe the histology of a lung biopsy specimen obtained from this patient?
- A. Cells with increased nuclear-to-cytoplasmic ratio
- B. Noncaseating granuloma
- C. Cellular debris and macrophages followed by cystic spaces and cavitation
- D. Macrophage filled with fungal microorganisms
- E. Epithelioid cells with caseous necrosis surrounded by multinucleated giant cells and lymphocytes (Correct Answer)
Abnormalities in wound healing Explanation: ***Epithelioid cells surrounded by multinucleated giant cells and lymphocytes***
- The patient's symptoms (fever, productive cough with hemoptysis, back pain, night sweats, HIV-positive status, and history of similar symptoms in Mexico) are highly suggestive of **reactivation tuberculosis (TB)**.
- The characteristic histological finding in **tuberculosis** is **caseating granulomas**, which are composed of epithelioid cells (activated macrophages) surrounded by lymphocytes and multinucleated giant cells (Langhans giant cells), with a central area of **caseous necrosis**.
*Cells with increased nuclear-to-cytoplasmic ratio*
- This description is typical of **malignant cells**, such as those seen in carcinoma, which is not the primary presentation given the historical and symptomatic context pointing towards infection.
- While lung cancer could cause some of these symptoms, the history of previous episodes and HIV points more strongly to an infectious etiology like TB.
*Noncaseating granuloma*
- **Noncaseating granulomas** are characteristic of diseases like **sarcoidosis** or **Crohn's disease**, which typically do not present with the described constitutional symptoms (e.g., night sweats) and hemoptysis in this context, especially with a history of HIV and prior infection.
- The presence of caseous necrosis is a key differentiator for tuberculosis granulomas.
*Cellular debris and macrophages followed by cystic spaces and cavitation*
- This describes the histological features of a **lung abscess** or extensive tissue destruction, which can be a complication of TB but is not the primary defining characteristic of the initial granuloma formation.
- While TB can lead to cavitation, the initial and most specific histological feature in active TB is the granulomatous inflammation.
*Macrophage filled with fungal microorganisms*
- This finding would suggest a **fungal infection** such as histoplasmosis or cryptococcosis, which can occur in HIV-positive individuals and present with similar symptoms.
- However, the strong clinical picture of prior similar illness in Mexico (an endemic area for TB), systemic symptoms, and hemoptysis, makes TB a more probable diagnosis, which is characterized by granulomas rather than direct macrophage colonization by fungi.
Abnormalities in wound healing US Medical PG Question 9: A 48-year-old man comes to the physician because of a 2-day history of fever, flank pain, and hematuria. He has chronic back pain, for which he has been taking meloxicam for the past 2 weeks. His temperature is 38.9°C (102°F). Physical examination shows a diffuse maculopapular rash over his trunk and extremities. Urinalysis shows 10–15 RBC/hpf, 20 WBC/hpf, and numerous eosinophils. Histologic examination of a kidney biopsy specimen is most likely to show which of the following findings?
- A. Interstitial T-cell infiltration (Correct Answer)
- B. Cortical cyst formation
- C. Glomerular crescent formation
- D. Mesangial IgA deposition
- E. Papillary necrosis
Abnormalities in wound healing Explanation: ***Interstitial T-cell infiltration***
- This patient's presentation with **fever**, **rash**, **eosinophiluria**, and acute kidney injury following meloxicam use is highly characteristic of **acute interstitial nephritis (AIN)**.
- AIN is a **type IV hypersensitivity reaction** characterized by inflammation and edema of the renal interstitium, with a predominant infiltrate of **T lymphocytes and eosinophils**.
*Cortical cyst formation*
- **Cortical cysts** are typically associated with **polycystic kidney disease**, which is a genetic disorder presenting with multiple cysts in the renal cortex and medulla, often leading to progressive renal failure over time.
- This condition does not explain the acute onset of **fever, rash, eosinophilia**, and acute kidney injury seen in this patient.
*Glomerular crescent formation*
- **Glomerular crescent formation** is characteristic of **rapidly progressive glomerulonephritis (RPGN)**, indicating severe glomerular injury often due to autoimmune diseases like **Goodpasture syndrome**, vasculitis, or lupus.
- While RPGN can present with **hematuria** and acute kidney injury, the presence of **rash, fever**, and especially **eosinophiluria** strongly points away from a primary glomerular disease and towards an interstitial process.
*Mesangial IgA deposition*
- **Mesangial IgA deposition** is the hallmark of **IgA nephropathy (Berger's disease)**, which typically presents with recurrent episodes of gross or microscopic hematuria, often triggered by an infection.
- It does not usually involve **fever, rash, or significant eosinophilia**, and the acute kidney injury in this case is more indicative of an allergic drug reaction.
*Papillary necrosis*
- **Papillary necrosis** is commonly associated with chronic analgesic abuse (**NSAID use**), **sickle cell disease**, or **diabetes mellitus**.
- While the patient is taking meloxicam, the acute presentation with **fever, rash**, and prominent **eosinophiluria** is a stronger indicator of allergic interstitial nephritis rather than papillary necrosis, which usually presents with chronic pain and hematuria, often with sloughed papillae in the urine.
Abnormalities in wound healing US Medical PG Question 10: A 3-year-old boy is brought to the physician for follow-up examination 5 days after sustaining a forehead laceration. Examination shows a linear, well-approximated laceration over the right temple. The wound is clean and dry with no exudate. There is a small amount of pink granulation tissue present. Microscopic examination of the wound is most likely to show which of the following?
- A. Angiogenesis with type III collagen deposition (Correct Answer)
- B. Macrophage infiltration and fibrin clot degradation
- C. Fibroblast hyperplasia with disorganized collagen deposition
- D. Capillary dilation with neutrophilic migration
- E. Acellular tissue with type I collagen deposition
Abnormalities in wound healing Explanation: ***Angiogenesis with type III collagen deposition***
- Five days post-laceration, the wound is in the **proliferative phase** of healing, characterized by the formation of **granulation tissue**.
- **Granulation tissue** consists of new blood vessels (**angiogenesis**) and proliferating fibroblasts that deposit **type III collagen** (which is later replaced by type I collagen).
*Macrophage infiltration and fibrin clot degradation*
- This describes events characteristic of the **inflammatory phase** (24-48 hours post-injury), where macrophages clean up debris and the initial fibrin clot.
- While some macrophages may still be present, the dominant microscopic feature at 5 days would be granulation tissue formation.
*Fibroblast hyperplasia with disorganized collagen deposition*
- Fibroblast proliferation and collagen deposition are indeed key features of the proliferative phase. However, specifying "disorganized collagen deposition" is somewhat less precise than angiogenesis and type III collagen, and **type III collagen** is characteristic of early granulation tissue rather than just general disorganized collagen.
- This option doesn't fully capture the active angiogenesis component which is prominent in granulation tissue.
*Capillary dilation with neutrophilic migration*
- This is characteristic of the **acute inflammatory response** occurring within the first 24-48 hours after injury.
- By day 5, neutrophils have largely been replaced by macrophages, and the inflammatory phase is transitioning into the proliferative phase.
*Acellular tissue with type I collagen deposition*
- **Type I collagen** deposition and scar maturation (leading to a more acellular tissue) occur much later, during the **remodeling phase** of wound healing, typically weeks to months after the injury.
- At 5 days, the tissue is highly cellular and vascular.
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