A 55-year-old diabetic male undergoes emergency laparotomy for acute peritonitis. On postoperative day 5, the surgical wound shows signs of dehiscence with serosanguinous discharge. Histologically, which phase of wound healing is most likely disrupted in this patient?

Explanation

## Wound Dehiscence in Diabetic Patient: Phase of Disruption **Clinical Context:** Postoperative day 5 dehiscence in a diabetic patient represents failure during the **proliferative phase** (days 3–21), not the inflammatory or hemostatic phases which occur earlier (0–3 days). **Why the Proliferative Phase is Disrupted:** - **Timing:** Day 5 falls squarely within the proliferative phase when fibroblasts should be actively infiltrating the wound, synthesizing collagen, and forming granulation tissue. - **Diabetes impairs:** Fibroblast recruitment, collagen synthesis, angiogenesis, and growth factor signaling—all hallmarks of the proliferative phase. - **Inadequate matrix formation** leads to poor wound strength, resulting in dehiscence. **Key Point:** The proliferative phase (3–21 days) is when wound tensile strength increases from ~5% to ~20%. Disruption here causes early mechanical failure. **Clinical Pearl:** Diabetic patients have impaired fibroblast function, reduced TGF-β signaling, and poor angiogenesis—all proliferative-phase defects. **High-Yield:** Dehiscence at day 5 = proliferative phase failure; dehiscence at day 1–2 = inflammatory phase or hemostatic failure (rare).