Understanding Wound Classification and Risks

Oct 15, 2024

Lecture on Wound Classification

Introduction

  • Presenter: Dr. Eric Pearson, Pediatric Surgeon
  • Topic: Understanding wound classification.
  • Importance: Helps predict risk of surgical site infections (SSI), which can lead to serious complications like systemic inflammatory response, sepsis, or fascial dehiscence.

Why Wound Classification Matters

  • Purpose: Classifying wounds places patients in risk groups for SSI.
  • Impact: Affects treatment plans and surgical outcomes.

Resources

  • Savison's Textbook of Surgery
  • Center for Disease Control (CDC) Definitions Paper on Wound Classification and SSI
  • Study: Evaluation of several hundred thousand patients regarding SSI incidence.

Types of Wound Classifications

1. Clean Wounds (Type 1)

  • Definition:
    • No infection, no crossing of a cavity or hollow viscous.
    • No break in sterile technique.
    • Primary closure without drainage.
    • No history of penetrating trauma (blunt trauma is possible).
  • Examples:
    • Excision of a ganglion cyst.
    • Laparoscopic hernia repair.
    • Procedures: Mastectomy, Thyroidectomy, Splenectomy, Ovarian resection, Hernia repairs.
  • Infection Risk: Low, 1-5% depending on comorbidities.

2. Clean Contaminated Wounds (Type 2)

  • Definition:
    • Controlled entry into a hollow viscous (e.g., respiratory, alimentary, genital, urinary tracts).
    • No evidence of existing infection.
  • Examples:
    • Laparoscopic cholecystectomy (without acute cholecystitis).
    • Colorectal surgery (without inflammation like diverticulitis).
  • Infection Risk: 3-11% depending on various factors.

3. Contaminated Wounds (Type 3)

  • Definition:
    • Presence of inflammation (e.g., appendicitis without gross contamination).
    • Major break in sterile technique.
    • Penetrating trauma (less than 4 hours).
    • Spillage of GI contents.
  • Examples:
    • Appendicitis with fecal contamination.
  • Infection Risk: 12-20%, influenced by multiple factors.

4. Dirty Wounds (Type 4)

  • Definition:
    • Old traumatic wounds (>4 hours old).
    • Presence of pus or purulent infection.
    • Perforated viscous (e.g., perforated appendicitis, diverticulitis).
  • Examples:
    • Incision and drainage of abscess.
    • Debridement of contaminated wound.
  • Infection Risk: Over 25%.

Timing of Wound Classification

  • When to Classify: Post-surgery, as circumstances during surgery (e.g., spillage, breaks in sterility) impact wound classification.

Study Insights

  • Study: Evaluation using ACS NISQIP database, over 600,000 patients.
  • Findings:
    • Clean: 2% superficial, 0.5% deep, 0.3% organ-space SSI.
    • Clean Contaminated: 4% superficial, 1% deep, 2% organ-space SSI.
    • Contaminated: 5% superficial, 1% deep, 2.6% organ-space SSI.
    • Dirty: 5% superficial, 2% deep, 5% organ-space SSI.

Conclusion

  • Summary:
    • Wounds are classified as clean, clean contaminated, contaminated, and dirty.
    • Classification occurs after surgery, impacting SSI risk assessment.
  • Next Steps: Look out for further videos on SSI.
    • Website and resources: citizensurgeon.com, with videos, reviews, and newsletters.

Final Note: Make sure to subscribe for more educational content and insights into surgical practices.