
The first fight in the Naxxramas Construct Wing, Patchwerk is a big squishy abomination.
25 Man
2-3 tanks, 5-7 healers, and the rest should be a mix of ranged and melee DPS.
10 Man
2 tanks. 2-3 healers, and the rest should be a mix of ranged and melee DPS.
The only special gear required here is for the Hateful Strike tank. They should stack as much avoidance and HP as possible. In general this fight will be a test of your healers and tanks:
Your main tank will need to be defence capped with 30-35k HP (25-30k HP in 10 man). Off tank(s) do not require defence capping, however 30-35k HP is recommended (25k HP unbuffed in 10 man).
Due to the nature of this fight, it is recommended that your healers are able to output a combined total of 15,000 HPS (Healing per second) across your tanks (5,500 HPS in 10 man). This is 3000 HPS each for 5 healers and 2142 HPS for 3 (in 10 man, this is 2,250 HPS each for 2 healers and 1833 HPS for 3). Due to the fight damage being largely based on how much damage your Hateful Strike tank(s) take you may find that, once the tanks’ gear improves beyond a certain level, healing becomes trivial.
All standard raid buffs are recommended. The Hateful Strike tank(s) should ideally use consumables to increase their HP pool.
It can be helpful to have a mage put Amplify Magic onto the tanks in order to aid healing since Patchwerk only uses physical abilities.

25 Man - 13 000 000 HP
Melee hit – Approximately 10 000 physical damage.
10 Man - 4 325 000 HP
Melee hit – Approximately 5 000 physical damage.
Hateful Strike: The main cause of problems in this fight. It hits the highest HP target in melee range that is not the main tank. It is also loosely based on aggro: if 2 players have the same amount of HP it will hit the highest on threat. This, however, will not be an issue as it can only hit someone in melee range and all non-tanks will have significantly reduced HP to avoid being hit by Hateful Strike. It hits for up to 25 000 (10 0000 in 10 man) physical damage every 1-1.5 seconds.
Berserk: This is the hard wipe ability used after 5 minutes. It increases Patchwerk’s damage done by 1000%.
Frenzy: At 5%, Patchwerk will gain Frenzy, hitting about twice as fast as before. Your tanks will need to save abilities such as Shield Wall or Icebound Fortitude for this.
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Your main tank and Hateful Strike tank(s) need to be close together before the fight starts in order to stop the tank getting killed by taking a melee hit and Hateful Strike hit in rapid succession on the pull (which will probably kill him). The melee will need to stand away before the tanks have the boss positioned. Either have a hunter Misdirect to the main tank or have the tank pull himself. Once the Boss is pulled and in position the melee DPS can move in.

This fight is mainly a test of your healers and tanks and whether or not they have the gear to survive the massive damage output. As soon as the fight starts the tanks will need to be healed non-stop until the fight is over; any delay in healing can easily lead to a wipe. As such, healers will only be focusing on healing the tanks and ignoring the rest of the raid.
Once the boss has been pulled into position the melee DPS can move in. It is recommended that they jump into the slime nearby to reduce their HP in order to lower the chances of being hit by Hateful Strike before they move in to begin DPSing, healers should avoid healing the melee entirely.
Ranged DPS can go all out from the start as long as they remain underneath the main tank in terms of threat.
Due to the relatively short Berserk timer the raid need to do 36 000 DPS (14 400 DPS in 10 man), which in standard raid gear will not be an issue for most guilds.
Main Tank: Build as much threat as possible to allow your DPS to go all out. Save your large cool downs (Shield Wall) for the 5% enrage.
Other Tanks: Try to mitigate the Hateful Strikes as much as possible using your skills and abilities; the less damage you take the better. Use the highest HP gear and buffs that you can in order to absorb any Hateful Strikes you take.
Healers: Be prepared to pre-heal the tanks. Once the fight starts you will chain cast healing spells on your target non-stop until the boss dies. Do not heal anything except the tanks.
Ranged DPS: Push out as much DPS as you can without over-aggroing the main tank.
Melee DPS: Wait until the boss is positioned then do as much DPS as possible without over-aggroing the main tank. It is recommended you jump in the slime before moving in to lower your HP and reduce the chances of being hit by a Hateful Strike.
Shamans can shine in this fight if you position your tanks close enough to be affected by Chain Heal.
If you are close to a kill (2-3%) but reach the Berserk, have everyone spread out in the room as much as possible to try and buy some time to DPS as Patchwerk runs between players.