Editing Necrotizing fasciitis (section)

===Surgery===
Aggressive wound debridement should be performed as soon as the diagnosis is made. The affected area may need to be debrided several times, usually once every 12–36 hours.<ref name="CDC2016" /> Large sections of tissue and muscle may need to be removed to prevent the infection from spreading. Amputation may be needed if the infection is too severe.<ref name="CDC2016" />

''En bloc'' debridement (EBd) is most commonly employed in treating NSTIs.<ref name=":3">{{Cite journal |last1=Suijker |first1=Jaco |last2=Zheng |first2=Kang Jing |last3=Pijpe |first3=Anouk |last4=Nasroe |first4=Farha |last5=Vries |first5=Annebeth Meij-de |date=2021-08-01 |title=The Skin-Sparing Debridement Technique in Necrotizing Soft-Tissue Infections: A Systematic Review |url=https://linkinghub.elsevier.com/retrieve/pii/S0022480421001025 |journal=Journal of Surgical Research |language=English |volume=264 |pages=296–308 |doi=10.1016/j.jss.2021.03.001 |issn=0022-4804 |pmid=33845413|url-access=subscription }}</ref>  This involves cutting away the skin overlying all diseased areas at the cost of increased scar formation and potential decreased quality of life post-operatively.<ref name=":3" />  More recently, skin-sparing debridement (SSd) has gained traction, as it resects the underlying tissue and sources of infection while preserving skin that is not overtly necrotic.<ref name=":3" />  However, more studies are needed to examine whether SSd actually accelerates the healing process after surgery.<ref name=":3" />
[[File:Fournier gangrene VSD.webp|thumb|Fournier gangrene and subsequent VSD]]
After the wound debridement, adequate dressings should be applied to promote wound healing.<ref name="Hak2014" /> Wounds are generally packed with wet-to-dry dressings and left open to heal.<ref name="CDC2016" /> In certain cases, vacuum-sealing drainage (VSD) may help the wound heal, especially in Fournier gangrene.

For necrotizing infection of the perineal area (Fournier's gangrene), wound debridement and wound care in this area can be difficult because of the excretory products that often render this area dirty and affect the wound-healing process. Therefore, regular dressing changes with a fecal management system can help to keep the wound at the perineal area clean. Sometimes, [[colostomy]] may be necessary to divert the excretory products to keep the wound at the perineal area clean.<ref name="Hak2014" />

<gallery widths="200px" heights="200px">
File:Open wound after debridement of NF.jpg|Wound after aggressive acute debridement of NF
File:Necrotizing fasciitis left leg debridement.JPEG|Necrotic tissue from the left leg surgically removed
File:Post surgical debridement and skin grafting..jpg|Postsurgical debridement and skin grafting
File:Knee Disarticulation Amputation.jpg|After knee disarticulation amputation
</gallery>