Basic Wound Dressing on a Surgical Wound

Michael M. Lawenko MD, FPCS, FPSGS, WCC

Joana S. Pajarillo MD

Introduction

A surgical wound is a cut or incision in the skin that is usually made by a scalpel during surgery. Surgical wounds
are made in a sterile environment where many variables can be controlled such as bacteria, size, location and
the nature of the wound itself. It is created in order to open the layers of tissue necessary to access the source
of disease or injury. Wounds should be monitored closely for signs of infection such as erythema, discharge,
swelling, tenderness, progression of extent.

Surgical wounds can be classified into four categories:

Class I: Clean Wounds

An incision in which no inflammation is encountered in a surgical procedure, without a break in sterile
technique, and during which the respiratory, alimentary and genitourinary tracts are not entered. Often involving
the eye, skin or vascular system.

Class II: Clean Contaminated

An incision through which the respiratory, alimentary or genitourinary tract is entered under controlled
conditions but with no contamination encountered. Wounds from GI tract procedures have a high risk of
becoming infected.

Class III: Contaminated wounds

An incision undertaken during an operation in which there is a major break in sterile technique or gross
spillage from the gastrointestinal tract, or an incision in which acute, non-purulent inflammation is encountered.
Open traumatic wounds that are more than 12–24 hours old also fall into this category.

Class IV: Dirty Contaminated

An incision undertaken during an operation in which the viscera are perforated or when acute
inflammation with pus is encountered during the operation (i.e., emergency surgery for fecal peritonitis). Also
includes traumatic wounds where there is significant delay in the treatment, and there is pus, fecal contamination
or devitalised/necrotic tissue present.

Wound Class Examples of Cases Expected

infection
rates

Clean (Class I) Hernia Repair, Breast Biopsy, 1-2%

mastectomy
Vascular Access
 Clean/Contaminated Cholecystectomy, elective GI 2.1-9.5%
(Class II) surgery (not colon)

Colorectal Surgery 4-14%

Contaminated (Class Penetrating Abdominal Trauma, 3.2-13.2%

III) large tissue injury, enterotomy
during bowel obstruction, i.e.
appendicitis

Dirty (Class IV) Perforated diverticulitis, Ruptured 3.1-12.8%

Appendicitis, necrotizing tissue
infections

*Schwartz Principles of Surgery 10th Edition