Aims: Severe necrotizing soft tissue infections (SNSTI) are characterised by rapid progression and high mortality. Purpose of this retrospective study is to review our experience with SNSTI emphasising clinical, diagnostic and treatment strategies, outcome and prognostic factors. Methods: 45 patients (26m/19f; mean age: 47.2 (14–82) years) with SNSTI involving skin, fascia and muscle, requiring critical care treatment, were included. Patientñs records were analysed for predisposing factors, clinical, diagnostic and treatment aspects and outcome. Results: Underlying diseases or injuries were arteriosclerosis (n=23) and diabetes (n=11). All cooperative patients reported on severe pain; swelling, erythema and necrosis generally occurred; the lower extremity was mostly affected (66.7%), followed by the abdomen (33.3%) and the upper extremity (6.6%). In 26.7% amputations were required; in all other cases repeated debridements were performed. Overall mortality rate was 17.8%. Increased mortality was associated with diabetes mellitus (38.5%), septic status (50%) and hemodynamic instability on admission (70.6%). Non-survivors showed higher age (p< 0.01), more often abdominal wall involvement (p< 0.001), increased lactate (p< 0.01), CK (p< 0.05) and decreased coagulation parameters (p< 0.02). Conclusions: A high index of suspicion, early clinical diagnosis, extensive adjusted surgical treatment, comprehensive critical care management and hyperbaric oxygen therapy are essential for successful management of frequently fatal SNSTI. Age, abdominal wall involvement and certain lab parameters (lactate, CK and coagulation status) turned out to be important prognostic markers.