Special approaches are required for management of infected wounds involving the hand. Care must be taken to consider involvement of joint, bone, and tendon, or tendon sheath as well as deep fascial spaces. The hand is also prone to infections with unusual microbiology that can result from animal and human bites as well as soil, plant, and water exposures. The special anatomic and microbiologic considerations are critical for selection of proper surgical and medical therapy to preserve function of this vital structure.