A healthy, 14-year-old girl presented with what was initially a minor hand abrasion with edema and apparent ecchymosis. Over the next 12 hours, dusky rings developed over the forearm. Key features leading to diagnosis were pain out of proportion to the injury and a CT scan that was positive for gas in the tissues. Optimal limb salvage was obtained with an integrated, multidisciplinary approach that included hyperbaric medicine, surgery, infectious disease, wound care, rehabilitation services, and behavioral health. Multiple surgeries included debridement, layered matrix dressings, and a split-thickness skin graft. The following case report discusses the etiology, diagnosis, mechanism of injury, and treatment of Type II necrotizing fasciitis. Unique problems that are encountered when treating pediatric patients with this problem are discussed and keys to successful outcomes are proposed.