During which healing phase do fibroblasts, myofibroblasts, and collagen peak to begin granulation tissue formation and angiogenesis?

• A. Inflammation
• B. Proliferation (fibroplastic)
• C. Remodeling (maturation)
• D. Acute care

Answer: (B)

The proliferative (fibroblastic) phase is when the wound is rebuilt with new connective tissue. In this stage, fibroblasts migrate into the wound and multiply, laying down collagen and other extracellular matrix components. Myofibroblasts arise from fibroblasts and help contract the wound edges, while capillaries grow into the area to restore blood supply. This combination of collagen production, wound contraction, and new blood vessel formation leads to granulation tissue—the pink, vascular tissue that fills and heals the wound. Because fibroblasts, myofibroblasts, and collagen activity peak here, this phase is when granulation tissue formation and angiogenesis are initiated.

Inflammation comes first, dominated by immune cells cleaning the area. Remodeling (maturation) follows later, reorganizing and strengthening the collagen to increase tensile strength. “Acute care” isn’t a distinct healing phase.