WOUND MANAGEMENT

Surgical wound classification:

• Clean
• Clean Contaminated: normal but colonized tissue
• Contaminated: contains foreign or infected material
• Infected: obvious pus present
• 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

Primary repair:

• 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

Delayed Primary Closure:

• Irrigate clean contaminated wounds, then pack open with damp saline gauze
• Close wounds with sutures at 2 days

Secondary healing:

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