Necrotizing soft tissue infections are a diverse group of severe infections of the skin, fascia, and musculature. These infections are characterized by the rapid and progressive destruction of soft tissue, as well as high incidence of morbidity and mortality. Prompt diagnosis, appropriate antimicrobial choice, and aggressive surgical interventions are essential in effecting a clinical cure and optimal outcomes for patients. Despite advances in medical care since necrotizing soft tissue infections were first described, the morbidity and mortality associated with them remains high. The etiology, pathophysiology, clinical presentation, diagnostic options, and treatment approach will be reviewed in this article.