Necrotizing fasciitis as a complication after vaginal vault suspension to the sacrospinous ligament

Suspension of the apical part of the vagina to the sacrospinous ligament is a well-established procedure for vaginal prolapse treatment. It is considered a safe procedure with a low complication rate. Necrotizing fasciitis is an extremely uncommon complication after sacrospinous ligament suspension of the vagina, and to our knowledge, only one case of this complication has been previously reported. This case presents a 79-year-old woman that underwent vaginal apical prolapse suspension to the sacrospinous ligament (Richter's procedure) and was later readmitted to the hospital due to a massive life-threatening necrotizing fasciitis of the right gluteal region in close proximity to the rectum, also spreading to the left gluteal side. A rapid response with extensive excision and repetitive debridement of the necrotic tissue in combination with effective intravenous antibiotics are crucial for the successful treatment.