ABSTRACT
Necrotizing soft tissue infections remain a highly lethal disease process. There has been a gradual improvement in survival over the decades from 40% or so down to around 20% currently. Debridements should continue on a daily basis until the surgeon is satisfied that there is no further necrotic progression. Frozen section biopsy was touted as the gold standard for diagnosis in the past, but has largely been supplanted by bringing the patient to the operating room to perform an open biopsy with visual confirmation to make certain of the diagnosis and proceeding with debridement as soon as possible. Even in the cases where the initial debridement is thought to be complete, the necrosis may continue to spread beyond the boundaries of the resection postoperatively, and a second look should be mandatory. After initial resuscitative care and source control, supportive critical care is necessary as patients undergo multiple debridements and recover from their septic insult.
