Necrotizing Soft-Tissue Infections: An Orthopaedic Emergency

Adam Lee, MD; Addison May, MD, FACS, FCCM; William T. Obremskey, MD, MPH


J Am Acad Orthop Surg. 2019;27(5):e199-e206. 

In This Article


Necrotizing soft-tissue infections have been present and documented since the time of Hippocrates. This disease process continues to have a high morbidity and mortality with approximately one third of patients undergoing amputation or death. Early diagnosis and surgical intervention is critical to minimize the severity of illness. Orthopaedic surgeons are commonly asked to differentiate cellulitis from a more aggressive necrotizing soft-tissue infection. We need to have a high index of suspicion and follow the progression of disease to identify when surgical intervention is critical. Resuscitation, broad empiric antibiotic therapy, and surgical débridement are required. Surgical débridement is time sensitive and similar to compartment syndrome because of its acuity which makes transfer of patients with a diagnosis of an necrotizing fasciitis challenging. Adjunct treatment in "toxic patients" may include IVIG or short-term high-dose corticosteroids.