Necrotizing soft tissue infections: Challenges and opportunities to improve patient outcomes

Necrotizing soft tissue infections (NSTIs) remain associated with high mortality rates. Improvements in patient outcomes have been limited, largely due to persistent challenges in early diagnosis, surgical management, and care organization. NSTI is frequently misdiagnosed at initial presentation, and uncertainty regarding tissue viability often necessitates wide surgical debridement, resulting in large wounds and substantial scarring. In addition, care pathways are frequently fragmented, thereby limiting access to specialized expertise. Nevertheless, recent years have seen promising opportunities emerge to address these challenges. Novel biomarkers, point-of-care ultrasound, and artificial intelligence may assist in earlier and more accurate diagnosis. Skin-sparing debridement, potentially guided by indocyanine green angiography, may reduce wound and scar size, while dermal substitutes may improve scar quality. Furthermore, the establishment of structured clinical networks, including designated expertise centers, could improve the organization and coordination of NSTI care. This narrative review summarizes current challenges in NSTI care and evaluates emerging strategies to improve diagnosis, surgical management, and care organization. Together, advances in these three domains have the potential to improve outcomes for patients with NSTI.