[The infected wound]

The therapy of infected wounds is based on the knowledge of the pathophysiology of infection and on early diagnosis. The development of an infection depends on the general condition of the patient, local factors like foreign body contamination and tissue necrosis and the pathogenicity of the bacteria. The diagnosis of a wound infection is made upon the classical symptoms dolor, rubor, calor, tumor and functio laesa and depends on continuous wound care and repeated clinical judgement. The differentiation between an abscess as encapsulated infection and a diffuse non localized phlegmonous inflammation has different therapeutic consequences as the surgical treatment of an abscess consists of incision and drainage whereas the excision of infected tissue is necessary in phlegmones. The wound revision is a special form of excision. The surgical debridement is the most effective part of the therapy. Excision of infected and necrotic tissue help the phagocytic cells in infection fighting and remove the ideal culture medium for bacteria. The use of antibiotics can be very helpful if stringent indications are applied. Additional therapeutic approaches like improvement of local oxygen supply and enhancement of phagocytic function of macrophages could support the surgical therapy of the infected wound.