Management of the Contaminated Operation

Abstract

The incidence of postoperative wound sepsis varies with the magnitude of contamination. The generally accepted classification of operative wounds according to contamination, as listed by Altemeier et al., is:

• 1) Clean

  • Nontraumatic

  • No inflammation encountered

  • No break in technique

  • Respiratory, alimentary, genitourinary tracts not entered

• 2) Clean-Contaminated

  • Gastrointestinal or respiratory tracts entered without significant spillage

  • Appendectomy—not perforated—no cloudy peritoneal exudate

  • Prepared oropharynx entered

  • Genitourity or biliary tract entered in absence of infected urine or bile

  • Minor break in technique

• 3) Contaminated

  • Major break in technique, or gross spillage from gastrointestinal tract

  • Traumatic wound, fresh

  • Entrance of genitourinary or biliary tracts in presence of infected urine or bile

• 4) Dirty and Infected

  • Acute bacterial inflammation encountered, without pus

  • Transection of “clean” tissue for the purpose of surgical access to a collection of pus

  • Perforated viscus encountered

  • Dirty traumic wound