Which of the following is classified correctly as clean-contaminated (class II) surgical wound?

• A. Bowel resection for peritonitis in a 72-year-old female
• B. Emergency splenectomy post-motor vehicle accident in an 18-year-old man
• C. Closed reduction of transverse fracture in an 85-year-old male post-fall
• D. Elective thoracotomy with left upper lobectomy in a 48-year-old smoker

Answer: (D)

Entering the respiratory, alimentary, or genitourinary tract under controlled conditions without any gross contamination defines a clean-contaminated wound. An elective thoracotomy with lobectomy fits this because the procedure opens the respiratory tract (airway structures) as part of the planned operation, but there is no infection or spillage of contents.

In contrast, a bowel resection performed for peritonitis involves contamination from the bowel and infected peritoneum, which makes it a contaminated or dirty wound. A trauma splenectomy without hollow-viscous injury generally remains clean if no infection or contamination is present, and a closed reduction of a fracture does not involve entry into a mucous membrane or body cavity with potential contamination, so it would be considered clean.