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There is a substantial need for evidence-based guidelines in the plastic surgery literature for pain optimization without the use of opioids. While this review of studies to date investigates potential solutions, we hope this area of study continues to be a top priority for plastic surgeons to allow for optimized post-operative care for patients following IBR.Diabetic foot ulcers (DFUs) combined with necrotizing fasciitis (NF) has rapid onset, involves a wide range of lesions, is difficult to treat, and has a high mortality rate. It