Which case scenario would be classified as clean-contaminated (class II) surgical wound in line with typical surgical wound classifications?

• A. Elective thoracotomy with left upper lobectomy in a 48-year-old smoker
• B. Closed reduction of transverse fracture in an elderly patient
• C. Emergency splenectomy after motor vehicle crash
• D. Bowel resection for peritonitis in a 72-year-old female

Answer: (A)

Clean-contaminated wounds occur when a mucous membrane tract is entered under controlled conditions, with minimal contamination and no active infection. Opening the respiratory tract during an elective chest surgery, such as a thoracotomy with lobectomy, fits this category because the airway is entered deliberately and under sterile technique, but there is inherent exposure to respiratory flora without established infection.

In contrast, a closed reduction of a fracture doesn’t involve entering a mucous tract, so it’s a clean wound. An emergency splenectomy after trauma carries a higher contamination risk due to traumatic injury and possible spillage or contamination of the abdominal cavity, making it contaminated or dirty. A bowel resection done for peritonitis involves an infected abdominal environment, classifying it as dirty-infected.