Which of the following factors classifies a wound as dirty?

• A. Foreign bodies, fecal contamination, and greater than 4 hours old
• B. Foreign bodies
• C. Greater than 4 hours old
• D. Fecal contamination

Answer: (A)

A wound is categorized as dirty when there is heavy contamination with foreign material and fecal matter, and there is enough time since injury for bacterial load to be established. The combination of foreign bodies, fecal contamination, and being older than four hours fits this definition, signaling a high risk of infection and devitalized tissue. When all three are present, it shows gross contamination with sustained bacterial burden, which places the wound in the dirty/infected category.

If a wound had only one of these factors—foreign bodies alone, fecal contamination alone, or being older than four hours alone—it would indicate contamination or increased infection risk, but not the dirty level by itself. This is why the trio of factors is the best indicator of a dirty wound. In management terms, dirty wounds typically require thorough debridement, broad-spectrum antibiotics, and often delayed closure.