Managing Necrotizing Soft Tissue Infections of the Lower Limb: Microsurgical Reconstruction and Hospital Resource Demands—A Case Series from a Tertiary Referral Center

<b>Background:</b> Necrotizing soft tissue infections (NSTIs) of the lower extremities represent a surgical emergency with high morbidity, complex reconstruction, and considerable healthcare demands. Free tissue transfer (FTT) is increasingly utilized for limb salvage in extensive soft tissue defects, yet its implications for hospital resource utilization remain unclear. This study aims to compare clinical outcomes and perioperative resource demands between FTT and local flap (LF) reconstruction in NSTI patients. <b>Methods:</b> A retrospective case series was conducted at a tertiary referral center between September 2022 and January 2025, including eight patients with NSTI of the lower extremity (FTT, <i>n</i> = 4; LF, <i>n</i> = 4). Demographic data, comorbidities, surgical timing, complication profiles, and resource utilization metrics-including operative duration, hospitalization length, and number of procedures-were analyzed. All FTT cases underwent preoperative CT angiography as part of institutional protocol. <b>Results:</b> Mean time to definitive reconstruction was longer in the FTT group (17.25 vs. 8 days, <i>p</i> = 0.15), reflecting staged infection control. FTT procedures demonstrated significantly longer operative times (331.75 vs. 170.25 minutes, <i>p</i> = 0.015), but there was no significant difference in total hospital stay (34.75 vs. 27.71 days, <i>p</i> = 0.65). No cases of flap loss or venous congestion were observed, and outcomes were optimized via delayed dangling protocols. <b>Conclusions</b>: FTT is a viable and effective reconstructive modality for lower extremity NSTIs. Despite increased surgical complexity, FTT did not significantly increase hospital resource utilization, supporting its role in limb preservation among appropriately selected patients.