A Systematic Review on Medical and Surgical Management of Necrotizing Fasciitis

Abstract

Background: Necrotizing fasciitis (NF) is a fulminant, life-threatening soft tissue infection characterized by rapid horizontal spread along deep fascial planes and high systemic toxicity. Despite significant advancements in critical care and antimicrobial pharmacotherapy, the condition continues to be associated with high mortality rates, primarily due to diagnostic ambiguity and delays in definitive surgical intervention. This review synthesizes current evidence to establish a standardized framework for medical and surgical management. Objective: The primary objective of this systematic review was to critically analyze contemporary literature regarding the early diagnosis of NF, the efficacy of laboratory scoring systems, optimized antimicrobial regimens, and the impact of surgical timing on patient survival. Methods: A systematic literature search was conducted across PubMed, Scopus, Embase, Web of Science, and Google Scholar for studies published through 2025. Adhering to PRISMA 2020 guidelines, we selected peer-reviewed systematic reviews, multicenter observational studies, and cohort studies focusing on diagnostic accuracy (LRINEC score, imaging), medical treatment (empiric antibiotics), and surgical outcomes (debridement timing). Results: The review of 24 studies identified early surgical debridement within the first 24 hours as the single most critical determinant of survival. While the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score serves as a useful adjunct for risk stratification, its limited sensitivity in early-stage disease makes it secondary to clinical judgment. Broad-spectrum empiric antibiotic therapy—specifically incorporating clindamycin for toxin suppression—was consistently associated with improved clinical stabilization. Bedside ultrasound and CT imaging proved valuable for anatomical mapping, though their use must not delay operative exploration in symptomatic patients. Conclusion: Successful management of necrotizing fasciitis requires a rapid, multidisciplinary "trinity" of care: high clinical suspicion leading to immediate surgical debridement, aggressive antimicrobial therapy, and comprehensive critical care support. Clinical awareness of pathognomonic red flags remains the most vital factor in mitigating the high morbidity and mortality associated with this surgical emergency.