Which healing outcome corresponds to healing by granulation tissue with tissue loss left open?

• A. Primary closure
• B. Delayed primary closure
• C. Secondary intention
• D. Tertiary intention

Answer: (C)

Healing by secondary intention occurs when a wound with tissue loss is left open to heal from the inside out. Granulation tissue forms in the wound bed to fill the defect, with new blood vessels growing in and fibroblasts laying down matrix. As this tissue fills, the wound contracts due to myofibroblast activity and epithelial cells migrate inward from the edges to restore surface continuity. Because the wound isn’t closed surgically, healing takes longer and typically results in more scar formation and some ongoing drainage or exudate. This scenario matches secondary intention, where tissue loss is left open to heal by granulation tissue rather than being closed immediately or after a delay. In contrast, primary closure involves bringing wound edges together at once; delayed or tertiary intention refers to leaving the wound open briefly to drain or resolve infection and then closing it later, which is different from healing by granulation tissue with the defect left open from the start.