Consensus on the diagnosis and treatment of adult necrotizing fasciitis (2025 edition)

Abstract

Necrotizing fasciitis (NF) is a disease characterized by severe infection of the skin and its underlying soft tissues as the initial symptom. NF is known for its difficulty in early diagnosis and rapid progression. If not treated promptly, NF can quickly evolve into systemic infection, sepsis, and multiple organ failure, and it may even lead to patient death. Currently, many controversies and challenges remain in clinical practice for the diagnosis and treatment of NF. To promote the standardization of NF diagnosis and treatment, Chinese Burn Association, Editorial Board of the Chinese Journal of Burns and Wounds, and Burn Medicine Branch of China International Exchange and Promotion Association for Medical and Health Care, based on the latest relevant guidelines, literature, and clinical practice experience and in accordance with the principles of evidence-based medicine, have jointly developed the Consensus on the Diagnosis and Treatment of Adult Necrotizing Fasciitis (2025 Edition) through repeated discussion and voting. This consensus aims to provide scientific and standardized guidance for clinical diagnosis and treatment.

Keywords

Necrotizing fasciitis / Multidisciplinary / Consensus

References

[1] Diab J, Bannan A, Pollitt T. Necrotising fasciitis. BMJ 2020; 27: m1428. https://doi.org/10.1136/bmj.m1428.

[2] Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, et al. Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59: e10-52. https://doi.org/10.1093/cid/ciu296.

[3] Ajitha MB, Archana CS, Avinash K. A study on necrotizing fasciitis with the etiological factors and microbiological aspects with its prevalence. Int J Surg 2020; 4: 167-71. https://doi.org/10.33545/surgery.2020.v4.i2c.413.

[4] Shivalingappa S, Manjunath KN, Waiker V, Kumaraswamy M, Odeyar U. Necrotising fasciitis: appearances can be deceptive. World J Plast Surg 2021; 10: 43-52. https://doi.org/10.29252/wjps.10.1.43.

[5] Fais P, Viero A, Viel G, Giordano R, Raniero D, Kusstatscher S, et al. Necrotizing fasciitis: case series and review of the literature on clinical and medico-legal diagnostic challenges. Int J Legal Med 2018; 132: 1357-66. https://doi.org/10.1007/s00414-018-1838-0.

[6] Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE working group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924-6.

[7] Chen PC, Tsai SH, Wang JC, Tzeng YS, Wang YC, Chu CM, et al. An elevated glycemic gap predicts adverse outcomes in diabetic patients with necrotizing fasciitis. PLoS One 2019; 14: 1-15. https://doi.org/10.1371/journal.pone.0223126.

[8] Clinical Guidelines Committee, Colorectal Surgeons Branch of Chinese Medical Doctor Association.Chinese expert consensus on diagnosis and treatment of perianal necrotizing fasciitis (2019). [In Chinese]. Chinese Journal of Gastrointestinal Surgery 2019; 22: 689-93.

[9] Eggert J, Di Giacomo A, Paolo VP. Diagnosis and treatment of type II necrotizing fasciitis in a child presenting with a minor abrasion, edema, and apparent bruising. Wounds 2009; 21: 74-8.

[10] Morgan MS. Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hosp Infect 2010; 75: 249-57. https://doi.org/10.1016/j.jhin.2010.01.028.

[11] Molewa MC, Ogonowski-Bizos A, Els M, Birtles CM, Kolojane MC. The microbiological profile of necrotising fasciitis at a secondary level hospital in Gauteng. S Afr J Infect Dis 2024; 39: 542. https://doi.org/10.4102/sajid.v39i1.542.

[12] Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Front Surg 2014; 1: 36. https://doi.org/10.3389/fsurg.2014.00036.

[13] Chen LL, Fasolka B, Treacy C. Necrotizing fasciitis: a comprehensive review.Nursing 2020; 50: 34-40. https://doi.org/10.1097/01.NURSE.0000694752.85118.62.

[14] Gönüllü D, Ilgun AS, Demiray O, Sayar S, Er AM, Kır G, et al. The potential prognostic significance of the Laboratory Risk Indicator for the Necrotizing Fasciitis (LRINEC) score in necrotizing fasciitis. Chirurgia (Bucur) 2019; 114: 376-83. https://doi.org/10.21614/chirurgia.114.3.376.

[15] Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg 2014; 51: 344-62. https://doi.org/10.1067/j.cpsurg.2014.06.001.

[16] Albadri Z, Salman K. Necrotizing fasciitis of the finger. IDCases 2019; 17: e00560. https://doi.org/10.1016/j.idcr.2019.e00560.

[17] Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004; 32: 1535-41. https://doi.org/10.1097/01.CCM.0000129486.35458.7D.

[18] Su YC, Chen HW, Hong YC, Chen CT, Hsiao CT, Chen IC. Laboratory risk indicator for necrotizing fasciitis score and the outcomes. ANZ J Surg 2008; 78: 968-72. https://doi.org/10.1111/j.1445-2197.2008.04713.x.

[19] Bechar J, Sepehripour S, Hardwicke J, Filobbos G. Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature. Ann R Coll Surg Engl 2017; 99: 341-6. https://doi.org/10.1308/rcsann.2017.0053.

[20] El-Menyar A, Asim M, Mudali IN, Mekkodathil A, Latifi R, Al-Thani H. The laboratory risk indicator for necrotizing fasciitis (LRINEC) scoring: the diagnostic and potential prognostic role. Scand J Trauma Resusc Emerg Med 2017; 25: 28. https://doi.org/10.1186/s13049-017-0359-z.

[21] Rodríguez-Roiz JM. Series of 41 cases of necrotizing fasciitis in a tertiary level hospital. Is it as deadly as we think? Is the LRINEC scale useful today? Acta Ortop Mex 2025; 39: 27-31. https://doi.org/10.35366/118849.

[22] Wu PH, Wu KH, Hsiao CT, Wu SR, Chang CP. Utility of modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score in distinguishing necrotizing from non-necrotizing soft tissue infections. World J Emerg Surg 2021; 16: 26. https://doi.org/10.1186/s13017-021-00373-0.

[23] Leiblein M, Marzi I, Sander AL, Barker JH, Ebert F, Frank J. Necrotizing fasciitis: treatment concepts and clinical results. Eur J Trauma Emerg Surg 2018; 44: 279-90. https://doi.org/10.1007/s00068-017-0792-8.

[24] Hsiao CT, Chang CP, Huang TY, Chen YC, Fann WC. Prospective validation of the laboratory risk indicator for necrotizing fasciitis (LRINEC) score for necrotizing fasciitis of the extremities. PLoS One 2020; 15: 1. https://doi.org/10.1371/journal.pone.0227748.

[25] Cribb BI, Wang MTM, Kulasegaran S, Gamble GD, MacCormick AD. The SIARI score: a novel decision support tool outperforms LRINEC score in necrotizing fasciitis. World J Surg 2019; 43: 2393-400. https://doi.org/10.1007/s00268-019-05061-4.

[26] Breidung D, Grieb G, Malsagova AT, Barth AA, Billner M, Hitzl W, et al. Time is fascia: laboratory and anamnestic risk indicators for necrotizing fasciitis. Surg Infect 2022; 23: 747-53. https://doi.org/10.1089/sur.2022.222.

[27] Tso DK, Singh AK. Necrotizing fasciitis of the lower extremity: imaging pearls and pitfalls. Br J Radiol 2018; 91: 20180093. https://doi.org/10.1259/bjr.20180093.

[28] Ballard DH, Mazaheri P, Raptis CA, Lubner MG, Menias CO, Pickhardt PJ, et al. Fournier gangrene in men and women: appearance on CT, ultrasound, and MRI and what the surgeon wants to know. Can Assoc Radiol J 2020; 71: 30-9. https://doi.org/10.1177/0846537119888396.

[29] Yoon MA, Chung HW, Yeo Y, Yoo HJ, Kang Y, Chee CG, et al. Distinguishing necrotizing from non-necrotizing fasciitis: a new predictive scoring integrating MRI in the LRINEC score. Eur Radiol 2019; 29: 3414-23. https://doi.org/10.1007/s00330-019-06103-0.

[30] Castleberg E, Jenson N, Dinh VA. Diagnosis of necrotizing fasciitis with bedside ultrasound: the STAFF exam. West J Emerg Med 2014; 15: 111-3. https://doi.org/10.5811/westjem.2013.8.18303.

[31] Menichetti F, Giuliano S, Fortunato S. Are there any reasons to change our behavior in necrotizing fasciitis with the advent of new antibiotics? Curr Opin Infect Dis 2017; 30: 172-9. https://doi.org/10.1097/QCO.0000000000000359.

[32] Lin CN, Hsiao CT, Chang CP, Huang TY, Hsiao KY, Chen YC, et al. The relationship between fluid accumulation in ultrasonography and the diagnosis and prognosis of patients with necrotizing fasciitis. Ultrasound Med Biol 2019; 45: 1545-50. https://doi.org/10.1016/j.ultrasmedbio.2019.02.027.

[33] Kehrl T. Point-of-care ultrasound diagnosis of necrotizing fasciitis missed by computed tomography and magnetic resonance imaging. J Emerg Med 2014; 47: 172-5. https://doi.org/10.1016/j.jemermed.2013.11.087.

[34] Fugitt JB, Puckett ML, Quigley MM, Kerr SM. Necrotizing fasciitis. Radiographics 2004; 24: 1472-6. https://doi.org/10.1148/rg.245035169.

[35] Headley AJ.Necrotizing soft tissue infections: a primary care review. Am Fam Physician 2003; 68: 323-8.

[36] Stamenkovic I, Lew PD. Early recognition of potentially fatal necrotizing fasciitis. The use of frozen-section biopsy. N Engl J Med 1984; 310: 1689-93. https://doi.org/10.1056/NEJM198406283102601.

[37] Bonne SL, Kadri SS. Evaluation and management of necrotizing soft tissue infections. Infect Dis Clin N Am 2017; 31: 497-511. https://doi.org/10.1016/j.idc.2017.05.011.

[38] Huang TY, Peng KT, Hsu WH, Hung CH, Chuang FY, Tsai YH. Independent predictors of mortality for Aeromonas necrotizing fasciitis of limbs: an 18-year retrospective study. Sci Rep 2020; 10: 7716. https://doi.org/10.1038/s41598-020-64741-7.

[39] Zhao-Fleming HH, Wilkinson JE, Larumbe E, Dissanaike S, Rumbaugh K. Obligate anaerobes are abundant in human necrotizing soft tissue infection samples-a metagenomics analysis. APMIS 2019; 127: 577-87. https://doi.org/10.1111/apm.12969.

[40] Qu D, Qiao DF, Klintschar M, Qu Z, Yue X. High-throughput 16S rDNA sequencing assisting in the detection of bacterial pathogen candidates: a fatal case of necrotizing fasciitis in a child. Int J Legal Med 2021; 135: 399-407. https://doi.org/10.1007/s00414-020-02421-x.

[41] Bellapianta JM, Ljungquist K, Tobin E, Uhl R. Necrotizing fasciitis. J Am Acad Orthop Surg 2009; 17: 174-82. https://doi.org/10.5435/00124635-200903000-00006.

[42] Jennifer H, Ali C, Magdum AA. Necrotising fasciitis: clinical judgement and early multidisciplinary collaboration is the key. Age Ageing 2022; 51: 1-2. https://doi.org/10.1093/ageing/afab197.

[43] Khamnuan P, Chongruksut W, Jearwattanakanok K, Patumanond J, Tantraworasin A. Necrotizing fasciitis: epidemiology and clinical predictors for amputation. Int J Gen Med 2015; 14: 195-202. https://doi.org/10.2147/IJGM.S82999.

[44] Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315: 801. https://doi.org/10.1001/jama.2016.0287.

[45] Carter PS, Banwell PE. Necrotising fasciitis: a new management algorithm based on clinical classification. Int Wound J 2004; 1: 189-98. https://doi.org/10.1111/j.1742-4801.2004.00054.x.

[46] Meng Z, Wang Y, Chao J, Ji Y, Sun Y, Zhu J, et al. Extensive necrotizing fasciitis of scrotum and abdominal wall: report of two cases and a review of the literature. Front Surg 2022; 19: 952042.

[47] Zhang N, Yu X, Zhang K, Liu T. A retrospective case series of Fournier’s gangrene: necrotizing fasciitis in perineum and perianal region. BMC Surg 2020; 20: 259. https://doi.org/10.1186/s12893-020-00916-3.

[48] Rampal S, Ganesan T, Sisubalasingam N, Neela VK, Tokgöz MA, Arunasalam A, et al. Local trends of antibiotic prescriptions for necrotizing fasciitis patients in two tertiary care hospitals in Central Malaysia. Antibiotics (Basel) 2021; 10: 1120. https://doi.org/10.3390/antibiotics10091120.

[49] Hadeed GJ, Smith J, O’Keeffe T, Kulvatunyou N, Wynne JL, Joseph B, et al. Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: a single academic center experience. J Emerg Trauma Shock 2016; 9: 22-7. https://doi.org/10.4103/0974-2700.173868.

[50] Kalaivani V, Hiremath BV, Indumathi VA. Necrotising soft tissue infection-risk factors for mortality. J Clin Diagn Res 2013; 7: 1662-5. https://doi.org/10.7860/JCDR/2013/5535.3240.

[51] Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am 2003; 85: 1454-60. https://doi.org/10.2106/00004623-200308000-00005.

[52] Sartelli M, Malangoni MA, May AK, Viale P, Kao LS, Catena F, et al. World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections. World J Emerg Surg 2014; 9: 57.

[53] Osbun N, Hampson LA, Holt SK, Gore JL, Wessells H, Voelzke BB. Low-volume vs high-volume centers and management of Fournier’s gangrene in Washington state. J Am Coll Surg 2017; 224: 270-275e1. https://doi.org/10.1016/j.jamcollsurg.2016.11.012.

[54] Ogilvie CM, Miclau T. Necrotizing soft tissue infections of the extremities and back. Clin Orthop Relat Res 2006; 447: 179-86. https://doi.org/10.1097/01.blo.0000218734.46376.89.

[55] Ozalay M, Ozkoc G, Akpinar S, Hersekli MA, Tandogan RN. Necrotizing soft-tissue infection of a limb: clinical presentation and factors related to mortality. Foot Ankle Int 2006; 27: 598-605. https://doi.org/10.1177/107110070602700806.

[56] Davies MRQ, Adendorff D, Rode H, van der Riet R le S. Colouring the damaged tissues on the burn wound surface. Burns 1980; 6: 156-9. https://doi.org/10.1016/0305-4179(80)90059-5

[57] Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017; 43: 304-77. https://doi.org/10.1007/s00134-017-4683-6.

[58] Chen SJ, Chen YX, Xiao JR, Wei XZ, Chen SM, Jiang WZ. Negative pressure wound therapy in necrotizing fasciitis of the head and neck. J Oral Maxillofac Surg 2019; 77: 87-92. https://doi.org/10.1016/j.joms.2018.08.016.

[59] Ji S, Liu X, Huang J, Bao J, Chen Z, Han C, et al. Consensus on the application of negative pressure wound therapy of diabetic foot wounds. Burns Trauma 2021; 9: tkab018. https://doi.org/10.1093/burnst/tkab018.

[60] Yongjun L, Mianzhi C, Zhihui Z, Zheng G, Pan Y. Clinical efficacy of ozone water irrigation combined with negative pressure wound therapy for the treatment of necrotizing fasciitis. Chin J New Clin Med 2019; 12: 1008-11.

[61] Burn and Trauma Branch of the Chinese Geriatrics Society.National expert consensus on the use of silver-containing dressings in wound management (2018 edition). Chinese Journal of Burns 2018; 34: 761-5.

[62] Zhu C, Zhang Z, Ma J, Tian Y. Applications of dry and moist wound healing therapies in the management of diabetic foot gangrene. Chinese Journal of Trauma and Tissue Repair (electronic edition) 2014; 9: 186-8.

[63] Holloway S, Ryder J. Management of a patient with postoperative necrotizing fasciitis. Br J Nurs 2002; 11: S25-32. https://doi.org/10.12968/bjon.2002.11.Sup3.10552.

[64] Momtaz D, Heath D, Ghali A, Krishnakumar HN, Schultz RJ, Gonuguntla RK, et al. Socioeconomic status affects amputation and mortality rates in necrotizing fasciitis patients. Int Orthop 2024; 48: 2505-12. https://doi.org/10.1007/s00264-024-06266-6.

[65] Khanna AK, Tiwary SK, Kumar P, Khanna R, Khanna A. A case series describing 118 patients with lower limb necrotizing fasciitis. Int J Low Extrem Wounds 2009; 8: 112-6. https://doi.org/10.1177/1534734609334809.

[66] Chang CP, Hsiao CT, Lin CN, Fann WC. Risk factors for mortality in the late amputation of necrotizing fasciitis: a retrospective study. World J Emerg Surg 2018; 13: 45. https://doi.org/10.1186/s13017-018-0207-0.

[67] Pei X, Hongling Z, Huan T, Zhongheng L, Xiangming Z. Clinical features and treatment outcomes of necrotizing fasciitis. Chinese Journal of Aesthetic and Plastic Surgery 2023; 34: 213-6.

[68] Breidung D, Billner M, Megas IF, Edo AM, Reichert B, Malsagova AT. Increase in streptococcal necrotizing fasciitis during and after the coronavirus disease 2019 pandemic. Surg Infect 2024; 25: 169-74. https://doi.org/10.1089/sur.2023.233.

[69] Siddiqui Z, Hadid S, Frishman WH. SGLT-2 inhibitors: focus on dapagliflozin. Cardiol Rev 2024; 26: 1-6. https://doi.org/10.1097/CRD.0000000000000694.

[70] Imai T, Kato N, Kanda N, Hashimoto H, Yamana H, Hatakeyama S. Risk of urogenital bacterial infection with sodium-glucose cotransporter-2 inhibitors: a retrospective cohort study using a claims database. Diabetes Ther 2024; 15: 1821-30. https://doi.org/10.1007/s13300-024-01613-7.

[71] Mascolo A, Zinzi A, Gaio M, Ruggiero D, Scavone C, Rossi F, et al. Safety of dapagliflozin and empagliflozin in cases with diabetes mellitus or/and heart failure: a retrospective pharmacovigilance study conducted on the EudraVigilance database. Pharmacol Rep 2025; 77: 274-86. https://doi.org/10.1007/s43440-024-00668-4.

[72] Efem SE.The features and aetiology of Fournier’s gangrene. Postgrad Med J 1994; 70: 568-71. https://doi.org/10.1136/pgmj.70.826.568.

[73] Sorensen MD, Krieger JN, Rivara FP, Klein MB, Wessells H. Fournier’s gangrene: management and mortality predictors in a population based study. J Urol 2009; 182: 2742-7. https://doi.org/10.1016/j.juro.2009.08.050.

[74] Hernández Martínez JO, Bertrand Noriega F, Ramírez Pedraza JM, Cosío Álvarez RA. Ischemic gangrene of the penis due to Fournier’s gangrene following traumatic transurethral catheterization: a case report. Urol Case Rep 2024; 56: 102820. https://doi.org/10.1016/j.eucr.2024.102820.

[75] Polistena A, Cavallaro G, D’Ermo G, Avenia N, De Toma G. Fournier’s gangrene: early diagnosis. How to diagnose, how to manage it. Minerva Chir 2014; 69: 113-9.

[76] El Hajjar C, Al Hassan J, Siblini M, Madi N, Abou Hammin S, Nakib H, et al. Comprehensive management and outcomes in female patients with Fournier’s gangrene: a case report. SAGE Open Med Case Rep 2024; 12: 1-5. https://doi.org/10.1177/2050313X241271829.

[77] Eray IC, Alabaz O, Akcam AT, Ulku A, Parsak CK, Sakman G, et al. Comparison of diverting colostomy and bowel management catheter applications in Fournier gangrene cases requiring fecal diversion. Indian J Surg 2015; 77: 438-41. https://doi.org/10.1007/s12262-013-0868-6.

[78] Spyropoulou GA, Jeng SF, Demiri E, Dionyssopoulos A, Feng KM. Reconstruction of perineoscrotal and vaginal defects with pedicled anterolateral thigh flap. Urology 2013; 82: 461-5. https://doi.org/10.1016/j.urology.2013.04.044.

[79] Matias MJR, Guimarães D, Vilela M, Sousa J, Bexiga J. Fournier gangrene-would you KISS it. GMS Interdiscip Plast Reconstr Surg DGPW 2023; 12: Doc12.

[80] Wahl P, Guidi M, Benninger E, Rönn K, Gautier E, Buclin T, et al. The levels of vancomycin in the blood and the wound after the local treatment of bone and soft-tissue infection with antibiotic-loaded calcium sulphate as carrier material. Bone Joint J 2017; 99-B: 1537-44. https://doi.org/10.1302/0301-620X.99B11.BJJ-2016-0298.R3.

[81] Zhong M, Guo J, Qahar M, Huang G, Wu J. Combination therapy of negative pressure wound therapy and antibiotic-loaded bone cement for accelerating diabetic foot ulcer healing: a prospective randomised controlled trial. Int Wound J 2024; 21: e70089. https://doi.org/10.1111/iwj.70089.

[82] Wu S, Xu Y, Guo L, Jiang X. A meta-analysis of the effectiveness of antibacterial bone cement in the treatment of diabetic foot skin wound infections. Int Wound J 2024; 21: e14487. https://doi.org/10.1111/iwj.14487.

[83] Chen H, Yao L, Zhou Y, Dai J. Evaluation of antibiotic-loaded bone cement in treatment of infected diabetic foot: systematic review and meta-analysis. Diabetes Metab Res Rev 2024; 40: e70002. https://doi.org/10.1002/dmrr.70002.

[84] Guo H, Xue Z, Mei S, Li T, Yu H, Ning T, et al. Clinical efficacy of antibiotic-loaded bone cement and negative pressure wound therapy in multidrug-resistant organisms diabetic foot ulcers: a retrospective analysis. Front Cell Infect Microbiol 2025; 14: 1521199. https://doi.org/10.3389/fcimb.2024.1521199.

[85] Du Y, Yu Y, Xu S, Yang J, Liu Y, Tang Y, et al. Antibiotic bone cement combined with vacuum sealing drainage effectively repairs sacrococcygeal pressure ulcer. Am J Transl Res 2024; 16: 4042-51. https://doi.org/10.62347/RYCD5610.

[86] Li L, Zhang G, Sun Y. Antibiotic bone cement accelerates diabetic foot wound healing-elucidating the role of ROCK1 protein expression. Int Wound J 2024; 21: e14945. https://doi.org/10.1111/iwj.14945.

[87] Guo X, Jin Z, Deng X, Huang Z, Xue M, Fanyu B. Clinical outcomes of antibiotic-loaded bone cement combined with negative pressure wound therapy for diabetic necrotizing fasciitis. Chinese Journal of Burns and Wounds 2023; 39: 1158-62.

[88] Hersant B, SidAhmed-Mezi M, Bosc R, Meningaud JP. Autologous platelet-rich plasma/thrombin gel combined with split-thickness skin graft to manage postinfectious skin defects: a randomized controlled study. Adv Skin Wound Care 2017; 30: 502-8. https://doi.org/10.1097/01.ASW.0000524399.74460.87.

[89] Çetinkaya RA, Yenilmez E, Petrone P, Yılmaz S, Bektöre B, ¸Simsek B, et al. Platelet-rich plasma as an additional therapeutic option for infected wounds with multi-drug resistant bacteria: in vitro antibacterial activity study. Eur J Trauma Emerg Surg 2019; 45: 555-65. https://doi.org/10.1007/s00068-018-0957-0.

[90] Chen X, Chen H, Zhang G. Management of wounds with exposed bone structures using an artificial dermis and skin grafting technique. Clin Plast Surg 2012; 39: 69-75. https://doi.org/10.1016/j.cps.2011.09.011.

[91] Hulsen J, Diederich R, Neumeister MW, Bueno RA Jr. Integra^® dermal regenerative template application on exposed tendon.Hand (N Y) 2014; 9: 539-42. https://doi.org/10.1007/s11552-014-9630-1.

[92] Writing group of experts consensus on clinical application of bilayer artificial dermis (2019 version). Experts consensus on clinical application of bilayer artificial dermis (2019 version). [In Chinese]. Chinese Journal of Burns 2019; 35: 705-11.

[93] Chen X, Song X. Cervical necrotizing fasciitis: a case series of seven patients and comprehensive literature review. Journal of Otorhinolaryngology and Ophthalmology of Shandong University 2016; 30: 65-72.

[94] Whitesides L, Cotto-Cumba C, Myers RA.Cervical necrotizing fasciitis of odontogenic origin: a case report and review of 12 cases. J Oral Maxillofac Surg 2000; 58: 144-51, discussion 152. https://doi.org/10.1016/S0278-2391(00)90327-6.

[95] Umeda M, Minamikawa T, Komatsubara H, Shibuya Y, Yokoo S, Komori T. Necrotizing fasciitis caused by dental infection: a retrospective analysis of 9 cases and a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 95: 283-90. https://doi.org/10.1067/moe.2003.85.

[96] Mastronikolis NS, Stathas T, Naxakis SS, Mallis A, Papadas T, Kalogeropoulou C, et al. Necrotizing fasciitis of the head and neck: report of 5 cases and review of the literature. Eur Rev Med Pharmacol Sci 2010; 14: 123-34.

[97] Kadri SS, Swihart BJ, Bonne SL, Hohmann SF, Hennessy LV, Louras P, et al. Impact of intravenous immunoglobulin on survival in necrotizing fasciitis with vasopressor-dependent shock: a propensity score-matched analysis from 130 US hospitals. Clin Infect Dis 2017; 64: 877-85. https://doi.org/10.1093/cid/ciw871.

[98] Hofmaenner DA, Wendel Garcia PD, Blum MR, David S, Schuepbach RA, Buehler PK, et al. The importance of intravenous immunoglobulin treatment in critically ill patients with necrotizing soft tissue infection: a retrospective cohort study. BMC Infect Dis 2022; 22: 168. https://doi.org/10.1186/s12879-022-07135-6.

[99] Sato S, Ito M, Sakai T, Kaneta A, Sato F. Successful treatment of streptococcal toxic shock syndrome with both diffuse peritonitis and necrotizing fasciitis. Case Rep Surg 2018; 2018: 1-4. https://doi.org/10.1155/2018/8260968.

[100] Eckmann C, Heizmann W, Bodmann KF, von Eiff C, Petrik C, Loeschmann PA. Tigecycline in the treatment of patients with necrotizing skin and soft tissue infections due to multiresistant bacteria. Surg Infect 2015; 16: 618-25. https://doi.org/10.1089/sur.2014.089.

[101] Petitpas F, Blancal JP, Mateo J, Farhat I, Naija W, Porcher R, et al. Factors associated with the mediastinal spread of cervical necrotizing fasciitis. Ann Thorac Surg 2012; 93: 234-8. https://doi.org/10.1016/j.athoracsur.2011.09.012.

[102] Ciavola L, Sogni F, Mucci B, Alfieri E, Tinella A, Mariotti ZE. Analgosedation in pediatric emergency care: a comprehensive scoping review. Pharmaceuticals (Basel) 2024; 17: 1506. https://doi.org/10.3390/ph17111506.

[103] Mugabo EN, Kulimushi YM, Pollach G, Sabra RA, Beltagy RS, Blaise Pascal FN. Clonidine and dexmedetomidine for controlled hypotension during functional endoscopic sinus surgery: a comparative study. BMC Anesthesiol 2024; 24: 425. https://doi.org/10.1186/s12871-024-02809-x.

[104] Cai W, Ma Y. Expert consensus on pain management in emergency trauma. Chin J Emerg Med 2022; 31: 436-41.

[105] Hull RD, Gersh MH. The current landscape of treatment options for venous thromboembolism: a focus on novel oral anticoagulants. Curr Med Res Opin 2015; 31: 197-210. https://doi.org/10.1185/03007995.2014.975786.

[106] Vascular Surgery Group, Surgical Branch, Chinese Medical Association.Guidelines for the Diagnosis and Treatment of Deep Vein Thrombosis (3rd edition). Chin J Vasc Surgery (Electronic Ed.) 2017; 9: 250-7.

[107] AlMarshad FA, Shah Mardan QNM, Mahabbat NA, Ijaz A, Bashaweeh R, Mrad MA, et al. Skin preservation in the debridement of necrotizing fasciitis: a demonstrative case report. Plast Reconstr Surg Glob Open 2022; 10: e4227. https://doi.org/10.1097/GOX.0000000000004227.

[108] Memar MY, Yekani M, Alizadeh N, Baghi HB. Hyperbaric oxygen therapy: antimicrobial mechanisms and clinical application for infections. Biomed Pharmacother 2019; 109: 440-7. https://doi.org/10.1016/j.biopha.2018.10.142.

[109] Mladenov A, Diehl K, Müller O, von Heymann C, Kopp S, Peitsch WK. Outcome of necrotizing fasciitis and Fournier’s gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years. World J Emerg Surg 2022; 17: 43. https://doi.org/10.1186/s13017-022-00448-6.

[110] Xiaolin L. Hyperbaric oxygen therapy for perianal necrotizing fasciitis: a report of 12 cases. Chinese Journal of Integrated Traditional and Western Medicine in Surgery 2013; 10: 88-9.

[111] Hung M, Chou C, Cheng L, Chung H, Ko N, Hsien C, et al. The role of hyperbaric oxygen therapy in treating extensive Fournier’s gangrene. Urol Sci 2016; 27: 148-53. https://doi.org/10.1016/j.urols.2015.06.294.

[112] Oguz H, Yilmaz MS. Diagnosis and management of necrotizing fasciitis of the head and neck. Curr Infect Dis Rep 2012; 14: 161-5. https://doi.org/10.1007/s11908-012-0240-1.

[113] Escobar SJ, Slade JB Jr, Hunt TK, Cianci P. Adjuvant hyperbaric oxygen therapy (HBO2) for treatment of necrotizing fasciitis reduces mortality and amputation rate. Undersea Hyperb Med 2005; 32: 437-43.

[114] Zheng J. Therapeutic efficacy of olanzapine in combination with antidepressants and anxiolytic agents for patients with anxiety and depressive disorders presenting with painful somatic symptoms. Practical Clinical Medicine 2017; 18: 11-4.

[115] Sudenis T, Hall K, Cartotto R. Enteral nutrition: what the dietitian prescribes is not what the burn patient gets! J Burn Care Res 2015; 36: 297-305. https://doi.org/10.1097/BCR.0000000000000069.

[116] Yang H, Zhu M, Wei C, Wang X. Clinical guidelines for parenteral and enteral nutrition in adult patients (2023 edition). Chin Med J 2023; 103: 946-73.

[117] Majeski JA, Alexander JW. Early diagnosis, nutritional support, and immediate extensive debridement improve survival in necrotizing fasciitis. Am J Surg 1983; 145: 784-7. https://doi.org/10.1016/0002-9610(83)90140-X.

[118] Graves C, Saffle J, Morris S, Stauffer T, Edelman L. Caloric requirements in patients with necrotizing fasciitis. Burns 2005; 31: 55-9. https://doi.org/10.1016/j.burns.2004.07.008.