Multistage reconstruction following extensive necrotizing fasciitis of the posterior trunk in a resource-limited setting: a case report.

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection requiring urgent debridement. Although infection control is paramount, timely reconstruction is equally critical to restore physiological stability and achieve durable closure. A 38-year-old woman with uncontrolled type 2 diabetes mellitus presented with extensive posterior trunk NF complicated by septic shock and diabetic ketoacidosis. Radical debridement created a 40 × 30 cm defect with exposed ribs, scapula, and thoracolumbar spinous processes. Reconstruction was staged. Rib corticotomy was performed to promote granulation, prominent spinous processes were reduced and covered with paraspinal muscle advancement, and definitive closure was achieved using two-stage 3:1 meshed split-thickness skin grafting. Postoperative management emphasized glycemic control, nutritional optimization, and pressure offloading. Complete graft take was achieved without donor-site complications. Staged reconstruction combined with structured postoperative care can achieve reliable closure in extensive posterior trunk NF, even in resource-limited settings.