American Board of Surgery Qualifying Exam (ABS QE) Practice Test

Which of the following is a key characteristic of the remodeling phase of wound healing?

1. Increase in the amount of collagen

2. Cross-linking of collagen fibers

3. High cell turnover

4. Significant inflammation

The correct answer is: Cross-linking of collagen fibers

The remodeling phase of wound healing is characterized by significant changes in the collagen structure, particularly through the cross-linking of collagen fibers. During this phase, which can last for months to years after the initial injury, the wound matures and strengthens. The collagen fibers that were laid down during the earlier inflammatory and proliferative phases are rearranged, cross-linked, and remodeled to provide greater tensile strength to the wound. The cross-linking of collagen fibers is crucial as it enhances the mechanical properties of the tissue, allowing it to better withstand physical stress. This process is essential for the stability and durability of the healed wound as it transitions into a more permanent state. Other factors, such as the increase in the amount of collagen and changes in cell turnover, do occur but are not the defining features of the remodeling phase. Likewise, while inflammation plays a pivotal role in the initial stages of healing, it should decrease significantly by the remodeling phase. Thus, the emphasis on cross-linking as the key characteristic highlights its vital role in providing structural integrity to the healing tissue.