Large wound or defect
After tissue removal, a wound remains that cannot simply be sewn up: it is closed with skin or a flap.
Soft tissue defect
CONDITION / TORSO AND ABDOMEN
Consequences of necrotizing fasciitis.
The consequences of necrotizing fasciitis are large defects of the skin, subcutaneous tissue, and muscles, coarse scars, and movement limitations that remain after a severe infection and life-saving surgeries. Recovery is staged: first the wounds are closed, then scar treatment, contouring, and mobility are addressed.
CONCEPTUAL VISUALIZATION- What it is
- Large tissue defects, scars, and movement restrictions after severe infection and surgeries that stopped it.
- Where it happens
- In a study of 409 patients with necrotizing infection — abdomen and perineal area (34%), legs (31%).
- Amputations
- In the same study, for limb involvement, amputation was required in 22% of patients.
- How to restore
- Stepwise: wound closure, then scars, contours, and movement; often — several surgeries.
01 / WHAT IS ITWhat remains
What remains
after necrotizing fasciitis.
Necrotizing fasciitis is a rare and life-threatening infection of the deep layers of the skin, subcutaneous tissue, fascia, and muscles. It develops within hours or several days, so it is treated in the hospital: intravenous antibiotics and emergency surgery, during which dead tissues are removed, often repeatedly.
To stop the infection, surgeons remove all dead tissue, sometimes along with the limb. After this, there are large wounds, and later — scars that tighten the skin and can interfere with movement. Even after successful treatment, the appearance of the body and how a person moves can change.
This page is about recovery when the infection has already been stopped: wound closure, scars, body contours, and movements. People come immediately after hospital discharge or months and years later.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSWhat worries
What worries
after infection.
The consequences depend on where the infection was and how much tissue had to be removed. They are often combined.
Scars and contractures
Scars tighten the skin, and near the joints they can limit movement.
Cicatricial deformation of the bodyPain and function
In a study of 22 patients, on average 59 months after fasciitis, pain troubled 72.7%, and half regularly used assistive devices.
Unstable scar
The scar cracks, becomes wet, or is covered with sores that do not heal — such an area should be shown to a doctor.
Unstable scarAfter amputation
If a limb had to be amputated, the stump is prepared for prosthetics.
Problematic stumpmood
In a study of 49 patients who survived necrotizing infection, 61.2% had post-traumatic stress scale scores at or above the threshold.
03 / REASONSWhy the consequences
Why the consequences
are difficult
The infection destroys tissues quickly, and it can only be stopped by radical surgery.
Rapid course
The infection develops within hours or days. The skin may initially appear normal or almost normal, while the deeper fascia rapidly deteriorates.
Radical surgery
Early removal of all dead tissue, including possible amputation, is necessary to reduce mortality. Therefore, post-surgery defects can be large.
Multiple surgeries
Dead tissues are removed repeatedly, and those who survive often undergo multiple surgeries, long hospital treatment, and rehabilitation.
Associated diseases
In a study of 409 patients, 41% had cardiovascular diseases, 24% had diabetes, and 30% had no comorbidities. Diabetes and weakened immunity increase the risk of this infection.
04 / SEEK MEDICAL ADVICE
When to seek urgent medical care?
Old consequences — scars, defects, movement limitations — routine situation, they usually do not require urgent care. But acute necrotizing fasciitis is 103: the infection spreads within hours.
103 immediately if:
- A wound, cut, or reddened, swollen area of skin hurts significantly more than it should;
- Blisters or black, purple, or gray spots appear near the wound or on the reddened area;
- Against the background of a wound or skin redness — high fever, headache, severe fatigue, or muscle aches;
- sudden confusion of consciousness;
- The heart is pounding, beating very fast, or irregularly;
- breathing is very frequent;
- Skin or lips are blue, pale, or blotchy.
Other levels of urgency:
Immediately - to the surgeon who operated, and if it does not work - to the reception department: The transplanted flap changed color (paled, turned blue, or darkened) or became cold. On the same day: The skin around the wound or scar hurts, is hot and swollen — see a doctor the same day; a wound after a skin or flap graft has become red, oozes pus, or has come apart — contact the surgeon who performed the operation. In the coming weeks: memories of illness, nightmares, anxiety, or depression return — see a doctor or psychologist: this happens often after a severe infection, and it can be managed with therapy. Planned: Scars that tighten the skin and limit movement, wounds that heal slowly, retracted areas — consultation with a plastic surgeon.
05 / DIAGNOSTICSAs planned
As planned
recovery
- Documents
Hospital discharge summaries, operation descriptions, culture results, and photos of wounds; which operations have already been done and what is bothering you the most.
- Review
The surgeon evaluates wounds and scars, joint movements, the condition of the surrounding skin, and areas from which skin can be taken for grafting.
- General condition
The doctor clarifies any concurrent diseases, particularly diabetes, and the medications you are taking — this affects the plan.
- Priorities
First — open wounds and scars that interfere with movement; contours and appearance — at later stages.
- Related specialists
Rehabilitation specialist, and if necessary — psychologist and doctor managing comorbidities.
06 / TREATMENTHow to restore
How to restore
Tissues after infection.
Restoration is staged. First, the infection is controlled in the hospital, then the wounds are closed, and after healing, work is done on scars, contours, and mobility. The goal of reconstruction is fewer limitations and a better appearance.
01
Wounds
As long as the wounds are not closed.
- Repeated cleansing
- Necrotic tissues are removed repeatedly until the wound becomes clean; simultaneously, antibiotics are administered intravenously.
- Vacuum dressing
- By reviewing the surgical aspects of treatment, vacuum therapy is useful to prepare the wound for closure and healing.
02
Closing the defect
- Skin grafting
- A large wound is closed with a thin layer of the patient's own skin taken from another area of the body.
- Patches
- If the wound cannot be closed with a skin graft, flaps — tissues with their own blood supply — are used. In a review of 888 flaps in 733 patients, local skin-fascial flaps predominated (71%), free flaps were rarely used (8%); partial or complete flap loss occurred in 3.3%. Most data are descriptions of patient series.
- Perineum and genital organs
- In Fournier's gangrene — necrotizing fasciitis of the perineum — based on a systematic review of 576 reconstructions, in 77.6% of cases simpler methods were sufficient: suturing, wound healing, skin grafting, or local flaps.
03
Scars and contours
- Combination of methods
- According to international recommendations, the best chances for hypertrophic scars are achieved by combining several methods.
- Laser
- An international group of 26 dermatologists and plastic surgeons from 13 countries named laser as a first-line method for traumatic scars and contractures.
- Own fat
- Lipofilling — transplantation of one's own fat — according to a meta-analysis of 9 randomized studies, reduced scars; the authors consider that it may be useful, especially together with other methods, but larger studies are needed for firm conclusions.
- Compression
- The scar tissue is excised and the skin is redistributed using local flaps (Z-plasty) or covered with a graft; after surgery — splints and rehabilitation.
04
Function and mood
- Quality of life
- In a study of 44 patients after fasciitis from five hospitals in the Netherlands, quality of life was lower than in the general population in several measures: physical functioning, limitations due to physical condition, vitality, and overall health. The authors recommend discussing realistic expectations and involving a physiotherapist or social worker.
- Rehabilitation
- After treatment, further surgeries and physical rehabilitation may be required.
- Psychological help
- In a study of 49 patients after necrotizing infection, depressive and post-traumatic disorders occurred more frequently than after septic shock from other causes. Signs of post-traumatic stress may appear immediately or after months.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
The consequences of necrotizing fasciitis at the Doctor Valikhnovskyi Institute of Surgery are treated under the 'New Body' program, while scars and contractures are handled together with the 'Reconstruction After Burns' program. Acute infection is treated in the surgical inpatient unit; the clinic takes over rehabilitation once the infection is controlled. Comorbidities are managed by the relevant specialist physician, and psychological support is provided by a psychologist.
CLINIC SERVICE
New body
Restoration of several areas of the body as a single sequence of stages — after injuries, major burns, or necroses.
View service
What we do for this condition
- Vacuum-assisted wound closure (NPWT) — a vacuum dressing drains exudate and prepares the wound for closure.
- Skin grafting — split-thickness or full-thickness graft; when there is little skin available for grafting — the Meek method.
- Dermal matrices — artificial dermis that is penetrated by its own vessels; a thin skin graft is placed on top.
- Local and free flaps — tissues with their own blood supply; free grafts are transplanted by sewing vessels under a microscope.
- Scars and contours — excision, Z-plasty, lipofilling of retracted areas, laser, expander for large areas.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend photos of wounds or scars and hospital discharge summaries — the doctor will preliminarily assess the situation.
- ConsultationReview of all affected areas, movements, and general condition; list of required examinations.
- Plan of stagesWhat to do first — wounds or scars that interfere with movement — and what next; approximately how many stages.
- OperationsClosure of wounds, then scars and contours — in stages, with intervals for healing.
- RecoveryDressings, compression garments on the scar, rehabilitation between stages; if necessary — psychological support.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
The infection has already been treated. When can reconstruction be considered?
Reconstruction begins once the infection is stopped and the overall condition is stable. Wounds are closed as soon as they are clean, and scars and contours are corrected later, after healing. Timing is determined by the surgeon after examination.
How many operations will be needed?
Usually a few: those who have gone through necrotizing infection often undergo several surgeries and prolonged rehabilitation. The surgeon explains the stages plan in advance.
Is it possible to manage with just a skin graft?
It depends on the defect. If the wound cannot be closed with a skin graft, flaps are used — tissues with their own blood supply. For Fournier's gangrene, according to the review of studies, 77.6% of reconstructions were simpler: suturing, skin grafting, local flaps.
Scars hurt and tighten. What can be done?
The scar tissue is excised and the skin is redistributed using local flaps, sunken areas are filled with autologous fat, and the scar surface is treated with a laser. According to international recommendations, the highest chance is given by combining several methods.
How can I tell if it's an infection again, rather than normal healing?
If the area around a wound or scar hurts much more than it should, blisters or black, purple, or gray spots appear, a high temperature rises on the background of the wound or redness, confusion appears, or very rapid heartbeat occurs — call 103. If the skin is painful, hot, and swollen without these signs — see a doctor the same day.
After the illness, I sleep poorly and constantly think about it. Is this normal?
This happens often: in a study of 49 patients who survived necrotizing infection, 61.2% had post-traumatic stress scale scores at or above the threshold. Contact a doctor or psychologist — therapy and medication help cope with this.
I had a limb amputated. Can you help with this?
The stump is prepared for prosthetics in the direction of 'Bionic Limb Prosthetics.' In a study of 409 patients, amputation was required in 22% of those whose limb was affected.
Sources
19 sources · guidelines, consensus documents, systematic reviews, cohorts, and NHSshowCollapse
- Necrotizing soft-tissue infections survival guide in adult patients: A position statement by the Global Alliance for Infections in SurgeryJournal of Trauma and Acute Care Surgery, 2026doi:10.1097/TA.0000000000004833 ↗
- 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infectionsWorld Journal of Emergency Surgery, 2018doi:10.1186/s13017-018-0219-9 ↗
- Necrotizing fasciitisThe Bone & Joint Journal, 2026doi:10.1302/0301-620X.108B9.BJJ-2026-0255.R1 ↗
- Necrotizing fasciitis: an update on epidemiology, diagnostic methods, and treatmentCurrent Opinion in Infectious Diseases, 2024doi:10.1097/QCO.0000000000000988 ↗
- Necrotizing Soft Tissue InfectionsInfectious Disease Clinics of North America, 2021doi:10.1016/j.idc.2020.10.004 ↗
- Patient’s characteristics and outcomes in necrotising soft-tissue infections: results from a Scandinavian, multicentre, prospective cohort studyIntensive Care Medicine, 2019doi:10.1007/s00134-019-05730-x ↗
- Management of Necrotizing Fasciitis and Its Surgical AspectsThe International Journal of Lower Extremity Wounds, 2015doi:10.1177/1534734615606522 ↗
- Flap coverage for necrotising soft tissue infections: A systematic reviewBurns, 2021doi:10.1016/j.burns.2021.01.005 ↗
- Fournier’s Gangrene Surgical Reconstruction: A Systematic ReviewJournal of Clinical Medicine, 2024doi:10.3390/jcm13144085 ↗
- Long-term quality of life in necrotizing soft-tissue infection survivors: a monocentric prospective cohort studyAnnals of Intensive Care, 2021doi:10.1186/s13613-021-00891-9 ↗
- Necrotizing fasciitis and the midterm outcomes after survivalSAGE Open Medicine, 2019doi:10.1177/2050312119842433 ↗
- Impact of severe necrotizing fasciitis on quality of life in the NetherlandsEuropean Journal of Trauma and Emergency Surgery, 2022doi:10.1007/s00068-022-02011-z ↗
- Updated international clinical recommendations on scar management: part 2 — algorithms for scar prevention and treatmentDermatologic Surgery, 2014pubmed.ncbi.nlm.nih.gov/25068544 ↗
- Laser Treatment of Traumatic Scars and Contractures: 2020 International Consensus RecommendationsLasers in Surgery and Medicine, 2020doi:10.1002/lsm.23201 ↗
- Effectiveness of fat grafting in scar reduction: A systematic review and meta-analysisJournal of Cosmetic Dermatology, 2022doi:10.1111/jocd.15067 ↗
- Necrotising fasciitisNHS, 2026nhs.uk/conditions/necrotising-fasciitis ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
- CellulitisNHS, 2024nhs.uk/conditions/cellulitis ↗
- PTSD (post-traumatic stress disorder)NHS, 2026nhs.uk/mental-health/conditions/ptsd-post-traumatic-stress-disorder ↗
The figures on the page are from these sources.
The consequences remained
severe infection?
Send photos of wounds or scars and hospital discharge summaries. The doctor will advise what can be restored and in what sequence.