Necrotizing soft tissue infections (NSTIs) continue to pose major problems in diagnosis and management.Review of the pertinent English-language literature.A high index of suspicion and good clinical judgment should be used in conjunction with laboratory and imaging studies in appropriate cases to establish the diagnosis as rapidly as possible. Successful treatment requires early, aggressive surgical debridement of all necrotic tissue, appropriate systemic antibiotic therapy, and supportive care to maintain oxygenation and tissue perfusion.The mortality rate of necrotizing soft tissue infection remains approximately 25% despite optimal care. Delayed definitive debridement remains the single most important risk factor for death.