question: Q:A 45-year-old man presents to the surgery clinic with an ulcer on his left heel, which he first noticed a week ago. He was surprised by the large size of the ulcer since because he had never noticed it before, and it was asymptomatic. The man also noticed fluid oozing out of the ulcer, which he has been wiping off with a clean cloth. He has had diabetes mellitus for the past 10 years and hypertension for the past 8 years. His medications include metformin and enalapril, although he tends to not take them as directed. His vital signs are normal. Examination of his left foot reveals a 3 cm x 3 cm ulcer with an irregular border and clear fluid over the base with erythema in the surrounding skin. An image of the lesion is taken and shown below. Laboratory investigations reveal the following:
  Capillary blood glucose (CBG) 340 mg/dL
  Hemoglobin (Hb%) 9.8 mg/dL
  White blood cell count (WBC) 16,000/mm3
  Erythrocyte sedimentation rate (ESR) 34 mm in the 1st hour
  The physician recommends wound debridement and prescribes an antibiotic for 1 week. The patient is also told to control his blood sugar by taking his medications regularly and paying better attention to his diet. He is also advised to change his dressing daily for the next 7 days. After 1 week, the patient’s ulcer begins to heal. Which of the following best describes the healing process of this patient’s lesion?? 
  {'A': 'A greater volume of granulation tissue is formed during healing by secondary intention, which results in a larger scar followed by wound contraction.', 'B': 'During the process of healing, large tissue defects have a greater volume of necrotic debris, exudate, and fibrin that aids with healing.', 'C': 'During healing by secondary intention, a small scar is formed, with minimal wound contraction.', 'D': 'In this type of healing, the inflammatory reaction is not intense, and healing is completed within 2 weeks.', 'E': 'During healing by secondary intention, the narrow space is first filled with fibrin-clotted blood; granulation tissue is formed later and covered by new epithelium.'},