Surgical Wound Classification Explained
Surgical wounds are classified based on the degree of contamination during the procedure. This helps predict infection risk.
- Clean wounds: Uninfected, no inflammation, non-penetrating tracts.
- Clean-contaminated wounds: Controlled entry into respiratory, alimentary, genital, or urinary tracts without unusual contamination.
- Contaminated wounds: Open, fresh wounds; major sterile breaks; gross GI contamination; purulent drainage.
- Dirty/Infected wounds: Old trauma, dead tissue, existing infection, or perforated organs.
Laparoscopic Cholecystectomy Classification
A laparoscopic cholecystectomy involves removing the gallbladder. Although performed using minimally invasive techniques and strict sterile protocols, this procedure involves entering the biliary tract, which communicates with the gastrointestinal tract and contains bacteria.
According to standard surgical wound classification systems (like the ASA classification), operations involving controlled entry into the gastrointestinal tract fall under the Clean contaminated category. This is because there is a potential, albeit controlled, for bacterial contamination from the gut.
Therefore, laparoscopic cholecystectomy is classified as a Clean contaminated surgical procedure.
Important Questions from Pre-operative & Post-operative Care
- A surgeon is about to start a laparoscopic procedure on a patient. The floor nurse asks the surgeon about the identity of the patient, site of the procedure to be performed and any anticipated critical events during the surgery. These questions are a part of the
- Perioperative benefit from transfusion is with a haemoglobin level of
- A 60 year old lady underwent total abdominal hysterectomy. On the 3rd post operative day she suddenly became breathless while returning from washroom. Her blood pressure recorded was $80/50$ mm of Hg. The most probable diagnosis is
- Perioperative benefit from transfusion is with a haemoglobin level of
- A 20 year old patient underwent open hernia surgery four days back. He is running fever for the last one day and on local examination the operated site was wet with pus and surrounding redness and edema. The appropriate management would be:
