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Bacteria are everywhere. Most are not pathogenic unless the right environment or quantity is present. A superficial infection in the medically compromised patient can provide a microenvironment conducive to precipitating wound sepsis, local, and systemic immune responses. Necrotizing fasciitis (NF) is a subtle yet bold infection that presents like cellulitis; however, beneath the surface of the integument, the ravaging products of cellular degradation are fulminant. Large dermal and subcutaneous involvement, creating significant tissue defects, require aggressive assessment and management by all members of the health care team.