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I am reviewing charts for a project and would appreciate opinions about wound classifications. The current classification system is old, and doesn't specifically address certain cases. The classification that I use is at the end of this post.
How would you classify a reentry laparotomy with infected mesh but no pus (III or IV)?
Ostomy creation (II or III)?
Ventral hernia repair when the patient has a colostomy or ileal conduit in place? Laparoscopic repair?
Socked in abdomen requiring lysis of adhesions (> 1 or 2 hr)? It is hard to call this class I , though this may be technically correct.
Repair of fresh fascial dehiscence when the skin is not broken? with noninfected drainage? evisceration?
Any ideas??
The classification that I use is a compilation of a few systems I found in the literature or textbooks:
Clean(Class I):
Non-traumatic (surgical wounds following blunt trauma are in this category if they meet all other criteria.
No inflammation or infection
GI, Resp or GU tract not entered
Primary closure +/- drains
Clean-contaminated (Class II):
GI or Resp tract entered under controlled conditions without unusual contamination
Contaminated (Class III):
Gross spillage from the GI tract
Open traumatic wounds < 4 hours old
Entrance into GU or biliary tract with infected urine or bile
Major break in technique
Dirty and Infected (Class IV):
Acute bacterial inflammation encountered, without pus
Transsection of "clean" tissue to access pus collection
Preoperative perforation of respiratory, gastrointestinal, biliary or genitourinary tract
Traumatic wound with retained devitalized tissue, foreign bodies, fecal contamination, and/or > 4 hours old; or from a dirty source
How would you classify a reentry laparotomy with infected mesh but no pus (III or IV)?
Ostomy creation (II or III)?
Ventral hernia repair when the patient has a colostomy or ileal conduit in place? Laparoscopic repair?
Socked in abdomen requiring lysis of adhesions (> 1 or 2 hr)? It is hard to call this class I , though this may be technically correct.
Repair of fresh fascial dehiscence when the skin is not broken? with noninfected drainage? evisceration?
Any ideas??
The classification that I use is a compilation of a few systems I found in the literature or textbooks:
Clean(Class I):
Non-traumatic (surgical wounds following blunt trauma are in this category if they meet all other criteria.
No inflammation or infection
GI, Resp or GU tract not entered
Primary closure +/- drains
Clean-contaminated (Class II):
GI or Resp tract entered under controlled conditions without unusual contamination
Contaminated (Class III):
Gross spillage from the GI tract
Open traumatic wounds < 4 hours old
Entrance into GU or biliary tract with infected urine or bile
Major break in technique
Dirty and Infected (Class IV):
Acute bacterial inflammation encountered, without pus
Transsection of "clean" tissue to access pus collection
Preoperative perforation of respiratory, gastrointestinal, biliary or genitourinary tract
Traumatic wound with retained devitalized tissue, foreign bodies, fecal contamination, and/or > 4 hours old; or from a dirty source