Classification of surgical wounds

Surgical wounds are classified based on the presumed magnitude of the bacterial load at the time of surgery.

Class I-Clean Wounds

Clean wounds are those wounds in which no infection is present.Only skin microflora contaminate the wound and no hollow viscus which contains microbes is entered.Infection rate is 1-5.4%

Eg: Hernia repair,breast biopsy

Class II – Clean contaminated wounds

Clean contaminated wounds are those wounds in which a hollow viscus such as respiratory, alimentary or genitourinary tracts with indigenous bacterial flora is opened under controlled conditions without significant spillage of contents.Infection rate is 2.1-9.5%

Eg:Cholecystectomy,Elective GI surgery

Class III -Contaminated wounds

Includes open accidental wounds encountered early after injury, those with extensive introduction of bacteria into normally sterile area of body due to major breaks in sterile technique(open cardiac massage),gross spillage of contents of viscus,incision through inflamed non purulent tissue.Infection rate  is 3.4-13.2% can be in 15-20% range.

Eg:Penetrating abdominal trauma,large tissue injury,enterotomy during bowel obstruction.

Class IV -Dirty wounds

Dirty wounds include traumatic wounds in which a significant delay in treatment has occurred and in which necrotic tissue is present ,overt infection evidenced by presence of purulent material and those created to access a perforated viscus accompanied by high degree of contamination.Expected infection rate is 3.1-12.1%.

Eg:Perforated diverticulitis,necrotizing soft tissue infections.

  1. infection rate of 4th degree wound is lesser than 3rd. is it correct?

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