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Plastic SurgeryManagement

Wound Classification and Closure Selection

Wound Classification and Closure Selection: Wound Requiring Closure → Wound Classification → Clean (Class I) → Reconstructive Ladder → Primary Closure.

Interactive Decision Tree

Mini Map

Algorithm Steps

  1. Start

    Wound Requiring Closure

    1. Decision

      Wound Classification

      • Clean (Class I)
      • Clean-contaminated (Class II)
      • Contaminated (Class III)
      • Dirty/Infected (Class IV)
      1. Action

        Clean (Class I)

        Primary closure appropriate

        1. Decision

          Reconstructive Ladder

          Simplest effective option

          1. End

            Primary Closure

            Direct suture approximation

          2. End

            Skin Graft

            STSG or FTSG based on location

          3. End

            Local Flap

            Advancement, rotation, transposition

          4. End

            Free Tissue Transfer

            Microvascular anastomosis required

      2. Action

        Clean-Contaminated (II)

        Primary closure with caution

      3. Action

        Contaminated (III)

        Delayed primary or secondary

        1. End

          Secondary Intention

          Allow granulation, wound care

      4. Action

        Dirty/Infected (IV)

        Secondary intention or delayed

Guideline Source

CDC Surgical Wound Classification / Reconstructive Ladder

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Closure timing depends on contamination level
  • Patient factors (nutrition, comorbidities) affect healing
  • Reconstructive elevator may replace ladder in some cases

Applicable Regions

USAUUKEU

UK: NICE wound management guidelines

US: CDC wound classification for SSI risk

Version 1Next review: 2028-01-01

Frequently Asked Questions

What is the Wound Classification and Closure Selection?

The Wound Classification and Closure Selection is a management clinical algorithm for Plastic Surgery. It provides a structured decision tree to guide clinical decision-making, based on CDC Surgical Wound Classification / Reconstructive Ladder.

What guideline is the Wound Classification and Closure Selection based on?

This algorithm is based on CDC Surgical Wound Classification / Reconstructive Ladder (DOI: 10.1097/PRS.0000000000008276).

What are the limitations of the Wound Classification and Closure Selection?

Known limitations include: Closure timing depends on contamination level; Patient factors (nutrition, comorbidities) affect healing; Reconstructive elevator may replace ladder in some cases. Individual patient factors may require deviation from these recommendations.

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