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Surgical Wounds

A surgical wound, also known as an incision, is a wound made by a cutting instrument such as a scalpel. 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.

Surgical wounds are made for a variety of reasons by highly trained health care professionals. In some cases of disease or injury, surgery is required to treat or further investigate the condition. In any surgical procedure, a surgical wound or incision will be created in order to open the layers of tissue necessary to access the source of disease or injury.

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The American College of Surgeons determines four classes of surgical wound types based on the wound’s level of contamination: clean, clean-contaminated, contaminated and dirty-infected. These classes allow health care professionals to better predict the risk of infections and wound healing outcomes, thereby allowing optimal treatment for each type of surgical wound.

Class I

Clean surgical wounds show no signs of inflammation and do not involve the respiratory, gastrointestinal or genitourinary tracts. Laparoscopic surgeries, surgeries involving the skin (such as biopsies), eye or vascular surgeries are good examples.

Class II

Clean-contaminated wounds are clean wounds with a higher risk of infection such as those involving the gastrointestinal, respiratory or genitourinary tracts, as long as the surgery is uncomplicated. Any wound opened to remove pins or wires, chest procedures, ear surgeries or gynecologic procedures are considered class II surgical wounds.

Class III

Contaminated wounds are created when an outside object comes in contact with the wound. This could be a bullet, knife blade or other pointy object. Or the contamination could be caused by large amounts of spillage from the GI tract into the wound. Any highly inflamed or infected tissue around a surgical wound is considered contaminated.

Class IV

Dirty-infected surgical wounds include those with a foreign object lodged in the wound (such as a bullet or other debris). This class also includes traumatic wounds from a dirty source where the treatment was delayed, infected surgical wounds or any wound that has been exposed to pus or fecal matter.

Surgical wounds are monitored closely for infection. Signs that a surgical wound is infected include:

Redness around the wound
The skin around the wound is hot to the touch
Drainage that is cloudy, discolored or foul smelling
Swelling
Fever
Increased pain to the area
The wound is larger or deeper

Risk factors for developing an infected surgical wound include:

Dirty or poorly maintained wound dressings
Wounds located near areas of contamination (such as near the mouth or groin)
Wounds contaminated by debris or foreign objects as seen in Class III and IV surgical wounds
Generally poor health or decreased immune function