Which finding indicates abnormal healing in a wound closed by primary intention?

• A. Pale and fragile granulation tissue
• B. Necrotic or slough tissue present in the wound base
• C. Drainage present more than three days after closure
• D. Presence of fistula, tunneling, undermining, and/or a fruity odor

Answer: (C)

In wounds closed by primary intention, healing should progress with the edges held together and only a small amount of drainage that decreases as the wound seals. When drainage persists beyond about three days after closure, it signals abnormal healing because the wound isn’t sealing properly and an infection or wound breakdown may be delaying the healing process. This persistent drainage is a practical, observable clue that something is disrupting normal closure.

Other signs can indicate problems, but they’re not as direct a signal in this context. Pale and fragile granulation tissue can occur with poor vascularity or other issues, but primary-intention wounds typically have minimal granulation because the edges are approximated. Necrotic or slough tissue at the wound base shows the bed isn’t clean enough to heal properly and needs debridement, which is important but not as specific to the ongoing healing status after closure as persistent drainage. Signs like a foul odor with drainage or the development of fistulas, tunneling, or undermining point to infection and structural breakdown, but the clearest early indicator of abnormal healing after primary closure is drainage that lasts beyond the expected healing window.