Wounds are classified as follows by the Centers for Disease Control and

Prevention (CDC)

Clean: An uninfected operative wound in which no inflammation is encountered and the

respiratory, alimentary, genital or uninfected urinary tracts are not entered. In addition, clean
wounds are primarily closed and, if necessary, drained with closed drainage. Operative incisional
wounds that follow non-penetrating (blunt) trauma should be included in this category, if they meet
the criteria.

Clean-Contaminated: Operative wounds in which the respiratory, alimentary, genital or urinary

tracts are entered under controlled conditions and without unusual contamination. Specifically,
operations involving the biliary tract, appendix, vagina and oropharynx are included in this category,
provided no evidence of infection or major break in technique is encountered.

Surgical Site Infection (SSI) Event: Center for Disease Control. 2010. http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf?agree=yes&next=Accept.
Updated January 2015. Accessed March 3, 2015. [Google Scholar]
 Clean wounds: close immediately to allow healing by primary intention

 Contaminated or infected wounds: never close, leave open to heal by

secondary intention

 Clean Contaminated: surgical toilet, leave open, then close 48 hours

later - delayed primary closure

Careless closure of a contaminated wound will promote infection and

delay healing
Contaminated: Open, fresh, accidental wounds. In addition, operations with major breaks in
sterile technique (e.g., open cardiac massage) or gross spillage from the gastrointestinal tract,
and incisions in which acute, non-purulent inflammation is encountered, including necrotic
tissue without evidence of purulent drainage (e.g., dry gangrene) are included in this category.

Dirty or Infected: Includes old traumatic wounds with retained devitalized tissue and those
that involve existing clinical infection or perforated viscera. This definition suggests that the
organisms causing post-operative infection were present in the operative field before the
operation.

Surgical Site Infection (SSI) Event: Center for Disease Control. 2010. http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf?agree=yes&next=Accept.
Updated January 2015. Accessed March 3, 2015. [Google Scholar]
 The reconstructive ladder. (Reproduced from Janis, Essentials of Plastic Surgery, 2nd edition, ©2014, Thieme Publishers, New York.
 Primary closure (primary intention)

 Wound edges are brought together so that they are adjacent to each other (re-
approximated)
• Primary closure requires clean tissue to be approximated without tension
• Leave skin sutures in place for an average 7 days; longer if healing expected to
be slow due to blood supply of particular location (back or legs) or patient’s
condition
• Close deep wounds in layers; absorbable sutures for deep layers

Emergency and Essential Surgical Care (EESC) programme www.who.int/surgery

 Secondary closure (secondary intention)

• Wound is left open and closes naturally (granulation)

• Perform wound toilet, surgical debridement without closure;
may need skin graft

Emergency and Essential Surgical Care (EESC) programme www.who.int/surgery

 Tertiary closure (delayed primary closure)

• Wound is left open for a number of days and then closed if it is found to be clean
• Irrigate clean contaminated wounds, then pack open with damp saline gauze
• Close wounds with sutures at 2 days

Emergency and Essential Surgical Care (EESC) programme www.who.int/surgery