[Pyogenic infections of the skin and skin appendages]

In Germany more than 120,000 soft tissue infections are treated in hospital per year. Articles about soft tissue infections caused by Strept. pyogenes, presented in the lay press as "flesh-eating bacteria", accentuate this picture. Among these soft tissue infections, necrotising fasciitis and the associated "toxic shock syndrome" and "toxic shock-like syndrome" remain a challenge to the surgeon. The most important role of surgery is to achieve the right diagnosis and introduce definitive therapy in time. Central to surgical therapy is immediate incision and open drainage. Our own experience in animal models underlines the important role of abscess pressure and physicochemical parameters in the "abscess compartment" for systemic spread. Based on this pathophysiological background, the traditional "ubi pus ibi evacua" has lost nothing of its importance.