Classification of surgical wounds

Classification of surgical wounds:  

• 1)  Clean wounds No break in sterile technique.  

                 No or minimal contamination from endogenous or exogenous sources.

                 No exploration of gastrointestinal,  genitourinary or respiratory tracts.  

                 Ellective procedure as thyroidectomy and hernial repairs.

                Wounds are primarily closed.

                Antibiotic prophylaxis is controversial.

                Risk of infection is 1-2%  

• 2)  Clean contaminated wounds:  

               Contamination by low number of microflora.

               Exploration of one of the 3 tracts with minimal spillage controlled opening of prepared colon.

               Emergency clean cases

               reoperate on clean wound within 7 days. 

               Minor break in sterile technique. 

               Antibiotic prophlaxis in 3 doses.  

               Risk of infection <10%

• 3) Contaminated wounds: 

           Contamination by large number of endogenous microflora.

           Exploration of one of 3 tubes with major spillage < 4 hours unprepared colon trauma Major break in sterile technique.

           Chronic open wound to be grafted or acute non purulent inflammation e.g acute non suppurative appendicitis.

            Antibiotic prophylaxis is continued to 3-5 days.

            Risk of infection 10-20%

• 4) Dirty wound: 

            Abscess drainage.

            Perforated viscus > 4 hours. Penetrating trauma > 4 hours.

            Antibiotic for 5-7 days.

            Risk of infection up to 40%

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