Wounds

Classification

What are the classification of wound according to bacterial infection?

Fav basic questions by surgeons

I remember this was one of the questions asked during OT and I could not answer.

4 Classifications most med students are able to name 2.
Clean wound
Clean-contaminated
Contaminated
Dirty

Clean wounds are wound that are created by the surgeon at a sterile site and at sites that we will not handle any septic material. These areas are breast, thyroid, hip fractures and such.

Clean Contaminated wounds are usually wounds pertaining to surgeries of the gut or the Respiratory system. Surgeries such as hemicolectomy or lung lobectomy where we create a sterile field and handle organs that are septic.

Contaminated wounds are those wounds that has a septic field introduced into the sterile field of the body from a pathology. Such as peritonitis secondary to ruptured appendicitis, or a ruptured diverticulitis.

Dirty wounds are usually referred to an external factor which causes a wound such as gunshot wounds, chainsaw, and such.

Why these classifications are important is because of the surgical site infection rate. The percentage of surgical site infection may range from different studies, but these are the general idea of the percentages.
Clean wound 1-10%
Clean contamintated 11-15%
Contaminated 16-30%
Dirty 30-50%

By having these classifications in mind, we may be able to provide a prophylactic emipirical antibiotic therapy according to the rates of infection.

To close or not to close?

What are the criteria to close a wound?

What type of wound closure would you choose?

Nursing notes

Usually this is done in the ED. A combination of history and physical exam is done to decide to close or not to close.

When did you get this wound?
What created this wound?
Any debris in the wound?
How is the skin edges?

These are the questions to ask ourselves before we close a wound.
Duration to close <6hours
Duration not to close >6 hours
Items to close by low speed weapon/object
Items not to close by High speed weapon/object
Close wound if minimal debris, such as sand or dirt
Dont close wound if large debris is present and if wound is deep
Close wound if edges are straight and smooth
Dont close wound if edges are jaggered

Usually these wounds are closed with simple interrupted sutures. Unless it is a deep wound, we may need to consider to use a muscular closure as well as a epidermal closure and keep patient monitored for surgical site infection.

Day what?

Post-op in ward, it is a common practice to perform a wound inspection. Usually which day would a surgeon turn on his radar for inspection of surgical site infection?

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