Medial Thigh Fasciocutaneous Flap for Perineoscrotal Reconstruction after Fournier’s Gangrene

Abstract

Fournier’s gangrene is a rare and potentially serious necrotizing fasciitis of the perineal and external genital area which warrants urgent, multidisciplinary management. Even with the availability of advanced intensive care, antibiotic therapy, and aggressive surgical debridement, survivors often have massive perineoscrotal tissue lesions, which represents an intricate reconstructive problem. We report a 31-year-old male with no previous medical history who developed advanced Fournier’s gangrene, leading to extensive scrotal loss of skin with bilateral exposed testicles. Management initially consisted of hemodynamic stabilization, broad-spectrum antibiotics, and surgical debridement which was repeated until complete control of the infection was reached. A definitive reconstruction was made with a long-pedicle medial thigh fasciocutaneous flap, resulting in stable coverage in a single phase. Partial donor-site dehiscence was observed in the postoperative period and controlled conservatively. A second operative procedure was then conducted with flap division and scrotal reconstruction with purse-string method, as well as split-thickness skin grafting of the donor site. The postoperative outcome after surgery was favourable and acceptable in terms of aesthetics and function. Erectile function was intact and sperm analysis was normal at follow-up. This case illustrates the reliability and functional advantages of the long-pedicle medial thigh fasciocutaneous flap in perineoscrotal reconstruction for Fournier’s gangrene.