[Necrotizing fasciitis of the extremities and trunk]

Necrotizing fasciitis (NF) is a disease of a group of entities with an aggressive course summarized under the term necrotizing skin and soft-tissue infections (NSTI). It is a life-threatening and often disabling infection and is primarily clinically diagnosed. Initially, clinical signs of infection can be insidious and confounded by absence of fever and typical cutaneous lesions. The later course is characterized by soft tissue lesions, excessive pain and systemic toxicity. As the infection can spread rapidly, and as a delay in treatment is associated with increased mortality, additional diagnostic imaging should be confined to a minimum. Prompt and radical surgical debridement (including repeated debridement after 24 h) is a prerequisite for survival in NF. Also, prompt administration of high-dose broad-spectrum antibiotics and a differentiated intensive treatment are necessary. The role of immunoglobulins and hyperbaric oxygenation remains controversial, therefore, the routine use of these measures cannot be recommended at the moment. Close interdisciplinary collaboration is required in order to optimize the treatment and to save life and limb of patients suffering from this life-threatening infection.