Successful care of surgical wounds begins with a comprehensive assessment of both the wound and the patient, including a clear understanding of the type and class of surgical wound. Psychosocial factors affecting healing and well-being, are essential to consider as well.1
Surgical wounds can be categorized through the following:
Surgical wound classification enables wound care professionals to tailor a care plan to each patient’s risk of complications.2
Wound healing type describes the method of wound closure as follows2-4:
Healing Type |
Definition |
Comments |
Primary intention |
Closed wound (all layers closed) with approximated wound edges |
Most common surgical wound type Rapid healing Minimal scarring and tissue loss |
Secondary intention |
Wound with deep layers. Closed and superficial layers left open to heal from the bottom up because of infection or an inability to approximate wound edges |
Slow healing Higher infection risk More extensive scarring
|
Tertiary intention |
Delayed primary closure, with the wound left open for several days initially |
Exudate drainage Control of contamination Preparation for further procedures |
The Centers for Disease Control and Prevention (CDC) classifies surgical wounds by the degree of wound contaminants, as shown here2-4:
Class |
Definition |
Class I/ Clean |
Operative wounds (usually skin, eyes, or vascular) with no signs of infection or inflammation No internal organ involvement Surgical site infection risk < 2% |
Class II/Clean-contaminated |
Operative wounds with no outward evidence of infection and no break in sterile technique Internal organ involvement Surgical site infection risk <10% |
Class III/Contaminated |
Open, fresh, accidental wounds involving internal organs or operative wounds with a break in sterile technique, gastrointestinal tract spillage, or incisions with acute, nonpurulent inflammation Also open traumatic wounds >12-24 hours old Surgical site infection risk <13%-30% |
Class IV/Dirty |
Wounds infected during operation, with visceral perforation or acute purulent inflammation Also delayed presentation of traumatic wounds with contamination and devitalized tissue already present Surgical site infection risk almost 40% |
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The following assessment protocol is partly adapted from the South West Regional Wound Care Program (London, Ontario, Canada)1:
Monitoring can prevent or minimize surgical site infections. Patients with symptoms of infection (surgical site pulling, persistent fatigue and malaise, warmth with pain, and foul odor) should contact their health care provider or surgeon immediately.8 The risk for complications is multifactorial and includes contamination, mechanism of injury contamination, systemic involvement, and presurgical conditions.2 For these reasons, knowledge of definitions, classifications, and assessment protocols for is essential to preventing and managing these challenging wounds effectively.
References
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.
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