The incidence of necrotising soft tissue infections (NSTI) has increased during recent decades such that most physicians might see at least one case of these potentially life-threatening infections in their career. Despite advances in care, NSTI are still associated with high morbidity and mortality, underlining a need for continued education of the medical community. In particular, failure to suspect NSTI fueled by poor awareness of the disease promotes delays to first surgical debridement, amplifying disease severity and adverse outcomes. This review will focus on practical approaches to management of NSTI including prompt recognition, initiation of specific management, exploratory surgery, and aftercare. Increased alertness and awareness for NSTI should improve time to diagnosis and early referral to specialised centers, with consequent improvement in NSTI prognosis.