[Wound infection and its treatment in accident surgery]

A so-called atraumatic operative technique is required to prevent post-traumatic wound infection. Especially in open fractures, closing a wound can lead to infection despite tension at the wound edges. Postoperative hematomas may also lead to infection, whereupon a further operation is necessary. Palliative treatment of the acute stages of infection consists in immediate evacuation, drainage and careful débridement. The wound must be closed without dead space remaining, but this proves impossible the dead space may be filled with a vascularized pedicle graft from adjacent muscle. The treatment of chronic infection, often accompanied by loss of skin and bone substance, has been improved by microsurgical techniques that allow the combination of autogenous bone grafting with vascularized musculocutaneous flap transplantation. Acute empyema requires early synovectomy.