Surgical Wounds

Q. 1 Which of the following statements are TRUE/FALSE among the statements given below, in relation to surgical wounds?

1. No antibiotics required in clean surgery
2. Incision of abscess is done in contaminated wounds
3. Spillage of stomach content converts a clean/contaminated wound case to a contaminated case
4. In clean/contaminated wounds infection rate is 10%
5. Hernial repair is contaminated wound

A		1,2,3 true & 4,5 false
B		3,4,5 true & 1,2 false
C		1,3,4 true & 2,5 false
D		All are true

Q. 1

Which of the following statements are TRUE/FALSE among the statements given below, in relation to surgical wounds?

A		1,2,3 true & 4,5 false
B		3,4,5 true & 1,2 false
C		1,3,4 true & 2,5 false
D		All are true

Ans. C

Explanation:

“Prophylactic systemic antibiotics are not indicated for patients undergoing low -risk, straightforward clean surgical operations in which no obvious bacterial contamination or insertion of a foreign body has occured.

SSi risk has traditionally been correlated to wound class.

The accepted range of infection rate has been 1% to 5% for clean, 3% to 11% for clean/contaminated, 10% to 17% for contaminated, and greater than 27% for dirty wounds”– sabiston 18/e page 301-03

Also know:

Surgical wound classification: (based on the presumed magnitude of the bacterial load at the time of surgery)

Clean wounds ( class I) include those in which no infection is present; only skin microflora potentially contaminate the wound, and no hollow viscus that contain microbes is entered.

Class ID wounds are similar except that a prosthetic device 9e.g. , mesh or valve ) is inserted.

Clean/ contaminated wounds (Class II) includes those in which a hollow viscus such as the respiratory, alimentary, or genitourinary tract with indigenous bacterial flora is opened under controlled circumstances without significant spillage of contents.

Contaminated wounds (Class III) includes open accidental wounds encountered early after injury, those with the extensive introduction of the bacteria into a normally sterile area of the body due to major break in the sterile techniques (e.g. Open cardiac massage), gross spillage of the viscus contents such as from the intestine, or incision through inflamed, albeit nonpurulent, tissue.

Dirty wounds (Class IV) include traumatic wounds in which a significant delay in treatment has occured and in which the necrotic tissue is present, those created in the presence of overt infection as evedeced by the presence of purulent material, and those created to access a perforated viscus accompanied by a high degree of contamination.

The microbiology of SSIs (surgical site infections) is reflective of the initial host microflora such that SSIs following creation of class I wound are invariable, due solely to skin microbes found on that portion of te body, while SSIs subsequent to a class II wound created for the purpose of elective colon resection may be caused by either skin microbes or colonic microflora, or both.

Table (sabiston 18/e, p 301): Wound class, Representative procedures, and expected infection Rates

Wound Class	Examples of class	Expected infection rate
Clean ( class I )	hernia repair, breast biopsy	1.0 – 5.4%
Clean/contaminated ( class II )	Cholecystectomy, elective GI surgery	2.1 – 9.5%
Contaminated (class III )	Penetrating abdominal trauma,large tissue injury, enterotomy during bowel obstruction	3.4 – 13.2%
Dirty (class IV )	perforated diverticulitis, necrotising soft tissue infections	3.1 – 12.8%

Table ( L&B 25/e, p 44 ) SSI rates relating to wound contamination

Type of surgery	Infection rate%	Rate before prophylaxis
Clean ( no viscus opened )	1 – 2	The same
Clean-contaminated ( viscus opened minimum spillage	< 10	Gastric surgery up to 30% Biliary surgery up to 20%
Contaminated ( opened viscus with spillage or inflammatory disease)	15 – 20	Variable but up to 60%
Dirty ( pus or perforation, or incision through an abscess)	< 40	Up to 60% or more

Ref: Sabiston, 18/e, page 301 ; L & B 25/e, page 44

Surgical Wounds

Surgical Wounds

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