The article reports the questions, which are associated with the interpretation of disease pathogenesis. The data are based on an analytical generalization of the follow-up study of 59 patients with necrotizing fasciitis in 2003–2011. The main component is stressed: disorders of microcirculation of superficial fascia as a result of thrombosis on basis of the hypercoagulation with outcome to necrosis, which was accompanied with POI syndrome, which manifested with severe form of sepsis (Hardaway theory) and can be considered as main cause of fatal outcome. The cause of high lethality is the not timely diagnostics and late performed operation.