Which healing type involves healing from the inside of the wound outward, with granulation tissue forming a bed before epithelialization occurs?

• A. Secondary intention healing
• B. Tertiary intention healing
• C. Regenerative healing
• D. Primary intention healing

Answer: (A)

This pattern describes secondary intention healing. When a wound has tissue loss or can’t be closed surgically, healing starts by filling the wound from the bottom up. Granulation tissue forms a vascular bed in the wound bed, providing the framework for new tissue. Once this bed is established, epithelial cells migrate over it to re-epithelialize the surface, effectively sealing the wound from the inside outward. Contraction also helps close the gap as myofibroblasts contract the wound margins. Because the wound heals through bed formation, slower tissue replacement, and more remodeling, it typically takes longer and leaves a larger scar than primary intention healing. In contrast, primary intention closes with edges opposed and minimal granulation, while tertiary intention delays closure to allow initial cleaning or tissue formation before final closure, blending features of both.