Management of Necrotizing Soft Tissue Infection

  • Heather Leigh EvansEmail author
  • Lena M. Napolitano
  • Eileen M. Bulger


Necrotizing soft tissue infection is a relatively rare, but highly morbid condition requiring immediate surgical evaluation and initiation of multimodal treatment. The key to effective treatment for NSTI is early recognition of the problem, facilitated by history and physical examination, as well as laboratory data. Imaging is rarely helpful and often only serves to delay definitive surgical evaluation and debridement. Severe systemic disease can manifest as septic shock and multisystem organ failure, and surgical source control is the mainstay of successful treatment, when combined with broad spectrum antibiotic administration and hemodynamic support to minimize progression of organ failure. It may be necessary to perform radical debridement, even amputation, to arrest progression of the disease, and interval reoperations should continue until no further debridement of necrotic tissue is needed. Adjunctive therapies may be helpful, but should be considered secondary and should not delay definitive surgical debridement or transfer to a facility if surgical intervention is not available.


Necrotizing fasciitis Necrotizing soft tissue infection Source control Septic shock Debridement Toxic shock syndrome Streptococcal sepsis 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Heather Leigh Evans
    • 1
    Email author
  • Lena M. Napolitano
    • 2
  • Eileen M. Bulger
    • 3
  1. 1.Department of SurgeryMedical University of South CarolinaCharlestonUSA
  2. 2.Department of SurgeryUniversity of MichiganAnn ArborUSA
  3. 3.Department of SurgeryUniversity of WashingtonSeattleUSA

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