D.Mahamed Hussein General Surgeon Azadi Teaching Hospital Surgical wounds D.Mahamed Hussein General Surgeon Azadi Teaching Hospital

What is a wound? It is a circumscribed injury which is caused by an external force and it can involve any tissue or organ. surgical, traumatic It can be mild, severe, or even lethal. Simple wound Compound wound Acute Chronic

Classification of wound 1. Based on the origin I. Mechanical: 1. Abraded wound. 2. Puncured wound. 3. Incised wound. 4. Cut wound. 5. Crush wound. 6. Torn wound. 7. Bite wound. 8. Shot wound.

Classification of wound 1. Based on the cause II. Chemical: 1. Acid 2. Base III. Wounds caused by radiation IV. Wounds caused by thermal forces: 1. Burning 2. Freezing V. Special

2.According to the wound depth Superficial Partial thickness Full thickness Deep wound

3.According to contamination Clean wound Clean-contaminated wound Contaminated wound Heavily contaminated wound

Wound Class I: Clean Respiratory, gastrointestinal, genital and urinary tracts not entered No break in aseptic technique No inflammation

Wound Class 1: Examples Breast surgery C-section with non-ruptured membranes Exploratory lap with no bowel resection Eye Surgery (unless inflamed, infected, or with foreign body) Hernia repair Total joint arthroplasty

Wound Class II: Clean-Contaminated Respiratory, gastrointestinal, genital, or urinary tract is entered under controlled conditions No major break in aseptic technique No acute inflammation No spillage

Wound Class II: Examples Cholecystectomy (chronic inflammation) Gastrointestinal procedures Gynecological procedures Urological procedures

Wound Class III: Contaminated Acute, nonpurulent inflammation is encountered Open, fresh, accidental wounds Operations with major breaks in sterile technique Visible spillage from intestinal tract Necrotic tissue without evidence of purulent drainage

Wound Class III: Examples Appendectomy (inflamed, no rupture, no pus) Bowel resection for infarcted and/or necrotic bowel Cholecystectomy with acute inflammation or bile spillage Compromised integrity of sterile field

Wound Class IV: Dirty/Infected Presence of purulence or abscess Perforated viscera Fecal contamination Traumatic wounds with retained devitalized (dying) tissue Wet gangrene

Wound Class IV: Examples Amputation in the presence of infection Exploratory lap for intra-abdominal abscess Incision & drainage for infection or abscess Ruptured appendix Ruptured bowel with or without fecal contamination Ruptured gastric ulcer

Risk of developing a postsurgical infection

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