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SURGICAL WOUND
CLASSIFICATION
Surgical wounds can be classified as follows:
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Clean |
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Clean
contaminated: a wound involving normal but colonized
tissue |
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Contaminated:
a wound containing foreign or infected material |
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Infected:
a wound with pus present. |
Factors
that affect wound healing and the potential for infection
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Patient:
– Age
– Underlying illnesses or disease: consider anaemia, diabetes or immunocompromise
– Effect of the injury on healing (e.g. devascularization) |
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Wound:
– Organ or tissue injured
– Extent of injury
– Nature of injury (for example, a laceration will be a less complicated
wound than a crush injury)
– Contamination or infection
– Time between injury and treatment (sooner is better) |
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Local
factors:
– Haemostasis and debridement
– Timing of closure |
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Infected:
a wound with pus present. |
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Close
clean wounds immediately to allow healing by primary
intention |
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Do
not close contaminated and infected wounds, but leave
them open to heal by secondary intention |
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In
treating clean contaminated wounds and clean wounds that
are more than six hours old, manage with surgical toilet,
leave open and then close 48 hours later. This is delayed
primary closure. |
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Many important procedures can be
performed under local anaesthesia and do not require
a surgical specialist
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In
most outpatient procedures, local or field block anaesthesia
will be sufficient but general anaesthesia, including
ketamine, may be necessary in children and should be
available
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Irrespective
of the seriousness of a wound, give initial management
priority to the airway, breathing and circulation
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Good
lighting and basic instruments are important for adequate
wound examination and management
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Work
efficiently to avoid prolonging the operation unnecessarily;
the risk of infection increases with time
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Universal
precautions are necessary to avoid the transmission of
the HIV, hepatitis, ebola and other vruses
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Clear the operative field of devitalized tissue and foreign
material
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While not a substitute for appropriate haemostasis, placement
of a drain is an option if a wound is oozing. The collection
of fluid and blood leads to increased risk of infection
and delayed healing
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Minimize dead space when closing a wound.
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