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Evaluation of Surgical Wounds

Practice Accelerator
September 22, 2023


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

Definitions and Classifications

Surgical wounds can be categorized through the following:

  • Incisional or excisional
  • Wound healing type
  • Infection risk

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



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 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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Assessment Protocol

The following assessment protocol is partly adapted from the South West Regional Wound Care Program (London, Ontario, Canada)1:

  1. Obtain a complete medical history, including medications, nutrition, wound history and pain, wound healing factors, and the patient’s goals and involvement in care.
  2. Perform a general physical examination, including a current pain assessment.
  3. Perform a psychosocial assessment, including the patient’s wound comprehension, financial concerns and support, the patient’s environment, and the patient and family’s functional, cognitive, and emotional ability to manage care.
  4. Note incision anatomic location and length, closure method (sutures, staples, glue, pins, or other external fixation6), closure status, hemorrhage, inflammation, condition of wound bed and periwound, and surgical drains.
  5. Complete a validated wound assessment tool (eg, the National Pressure Injury Advisory Panel PUSH [Pressure Ulcer Scale of Healing] Tool 3.05) and repeat at least weekly to monitor wound healing and care.
  6. Assess the wound for increased bioburden, including hemopurulent or seropurulent wound drainage 48 hours postoperatively, incision site abscess or breakdown, or spontaneous dehiscence.
  7. Assess wound moisture balance and dressing appropriateness.
  8. If the surgical wound is on the lower leg, assess the leg for edema, lymphedema, lipidema, vascular disease, and circulation.
  9. If a patient with diabetes and/or neuropathy has a surgical foot wound, obtain the patient’s treatment history and diabetic complications. Assess the patient’s feet and toenails for deformity, range of motion, neuropathy, and infection. Also assess gait, footwear, and edema, lymphedema, lipidema, vascular disease, and circulation.
  10. Assess and monitor any sutures, staples, and glue sites,7 as well as external fixation devices,6 and make sure an order is in place for removal. Timing of suture (nonabsorbable) or staple removal varies from 3 to 21 days.3
  11. Determine wound healability.
  12. Document all findings meticulously.

Monitoring for Surgical Site Infection

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.


  1. South West Regional Wound Care Program. Surgical wounds assessment guide. 2020. Accessed September 2, 2023.
  2. Surgical wounds 101. Practice Accelerator. WoundSource. 2018. Accessed August 31, 2023.
  3. American College of Surgeons. Wound Home Skills Kit: Surgical Wounds. 2018. Accessed August 31, 2023.…
  4. Herman TF Bordoni B. Wound classification. In: StatPearls [Internet]; 2022. Accessed August 31, 2023.
  5. Swezey L. Wound assessment tools. WoundSource. 2015. Accessed August 31, 2023.…
  6. Clinical guidelines (nursing): Pin site care for the child with an external fixator. Royal Children’s Hospital Melbourne. Accessed September 3, 2023.…
  7. Azmat CE, Council M. Wound closure techniques. StatPearls [Internet]. 2023. Accessed September 2, 2023.
  8. Assessment of surgical wound infections. Practice Accelerator. WoundSource. 2019. Accessed September 2, 2023.

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.