Necrotising fasciitis of the hand: emergency management and early functional reconstruction with scapular and parascapular free flap

Necrotising fasciitis is a rare and rapidly progressive infection that demands early diagnosis and aggressive management to prevent fatal outcomes. We present a case of a woman in her 70s who developed a necrotising fasciitis of the hand and forearm after a minor thumb injury while cleaning artichokes.The initially underestimated wound progressed rapidly, requiring multiple surgical debridement. After clinical stabilisation, a complex full-thickness defect remained, exposing critical structures. Reconstruction was performed using scapular and parascapular free flap, ensuring excellent functional recovery. This case highlights the importance of early recognition and aggressive management of necrotising fasciitis. It also underlines the role of the reconstructive surgeon in restoring both form and function, balancing adequate excision of non-viable tissue with the risk of over-debridement. We find it potentially beneficial to discuss our management of this case because practical difficulties often arise due to the rarity and complexity of these conditions.