Classification of operative wounds

We Have to understand that not all surgical wound are same in the risk to become infected after surgical procedures there are many factors affecting the risk of acquiring infection or what is called Risk Index( RI) one of those factors is the wound class that are classified into four categories (Classes) this for proper surveillance of the Surgical Site Infections

classification of operative wounds

classification of operative wounds

CLASS I. Clean Wound

 

This type of surgical procedure which didn’t enter the Alimentary, Respiratory or Urinary track and the surgical is Elective and not traumatic and no inflamation, infection or cellulitis in the field or in other organs or sites close to the wound plus no break in the aseptic technique during the operation and the wound end by primary closure (if needed a closed wound draining system can be used)

 

Remember that all clean wounds happened during the elective operation but not vice versa (not all elective operation can be considered a clean wound)

 

 

CLASS II. Clean Contaminated Wound

 

This kind of wound class is designated to operative procedure where the Genital, Biliary , Alimentary ,respiratory ,urinary tracts are entered with controlled circumstances in absence of significant contamination and no evidence of infection is present and can be minor break in the operative technique , the wound can be closed primarily even in many cases it needs mechanical drainage

 

In this class we have many surgical procedures e.g.:

Abdominal Aortic Aneurysmectomy Adrenalectomy Aorto-bifemoral Bypass Aorto-Coronary Bypass Amputations (unless infected)
AV Fistula Arthroplasty Arthroscopy Blepharoplasty Bone Graft
Breast Biopsy Bunionectomy Cataract Surgery Carotid Endarterectomy Carpal Tunnel
Circumcision Embolectomy Exploratory Laparotomy Eye Surgery (Elective) Femoral-popliteal  Bypass
Ganglion cyst Herniorrhaphy Hip Nailing Hydrocelectomy Laminectomy
Laparoscopy Lumpectomy Marshall-Marchetti Mastectomy (including radical) Neurosurgery
Oophorectomy    Orchiectomy Orchiopexy Ovarian Cystectomy Pacemaker Placement Parotidectomy
Radical Neck (outside incision) Salpingo-oophorectomy Skin Graft Splenectomy Sympathectomy
Thyroidectomy Parathyroidectomy Total Joint Replacement Vein Stripping Vascular Surgery (unless infected)
Vasectomy    (only if uninfected) Abdominal Hysterectomy Abdominal Perineal Resection (prepped) Appendectomy Anterior & Posterior Repair
Bowel Resection (prepped) Bronchoscopy Cervical Cone Biopsy Cesarean Section Cholecystectomy (open or laparoscopic)
Colostomy Closure Colposcopy Cystoscopy Dental Surgery D & C
Esophagoscopy Esophagectomy    Episiotomy Gastrectomy (vagotomy) Intranasal Surgery (No Inflammation) Laceration < 8 hrs. old
Laparoscopy Laryngoscopy Laryngectomy LAVH Mastoidectomy
Nephrectomy (if urine is sterile) Myringotomy Open Fractures < 10 hrs. Old Paranasal Sinus Surgery Pilonidal Sinus Surgery
PEG Tube Insertion Pneumonectomy/Lobectomy/ Wedge Resection    Polypectomy Prostate Biopsy Radical Neck (if mouth/ trachea involved) Rectal/Vaginal Surgery
Small Bowel Surgery Sigmoidoscopy Stapedectomy Tonsillectomy & Adenoidectomy Tracheostomy
Prostatectomy TURP Tympanoplasty Thoracotomy Tubal Ligation
Ureterolithotomy Ureteroscopy Whipple

 

CLASS III. Contaminated Wound

 

this wound class happened in (mainly )contained infection in the Urinary , alimentary , Genital  tracts where gross inflamation and presence of active infections or cellulitis and there is major break in the surgical technique and most of the contaminated wounds are partially closed or even not closed and kept for drainage

Examples of clean contaminated wounds :

Appendectomy (with perforation/ peritonitis) Bowel Resection (with peritonitis/perforation) Burns (debridement) Cholecystectomy (positive culture) Diverticulectomy
Gun Shot Wound (involving bowel) Intranasal Surgery Lacerations > 8 hrs. old Nephrectomy (bacteriuria) Open Fractures > 10 hrs. old
Stab Wounds Traumatic Wounds > 10 hrs. old

 

CLASS IV. Dirty wound

 

The dirty wound where the patient already has a current septicemia or bacteremia and a gross contamination with infected materials or spillage from viscous and active infection e.g. abscess or devitalized tissue or foreign body with infection is present

 

NB: None of dirty wounds can be primarily closed , and this kind of wound is not entitled for Prophylactic antibiotics 

 

Remember the wound class is not rigid classification there are certain factors can increase the wound class from clean to dirty e.g.

 

  • Delayed treatment of traumatic
  • Significant acute, no purulent inflammation
  • Delayed primary closure
  • Major breaks in technique
  • Presence of pus

 Reference

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