Necrotizing soft tissue infections (NSTIs) present a rare but devasting disease process for affected patients. Timely diagnosis and management of this condition is essential for critical care providers to obtain optimal patient outcomes. Given their rarity, NSTIs are often diagnosed late in the disease process, contributing to an increase in morbidity and mortality among these patients. In this review, we discuss how to classify these infections, their risk factors, pathophysiology, clinical presentation, diagnosis, scoring systems and treatment, with an emphasis on surgical management.