Fertility-sparing Scrotal Reconstruction with a Superficial Circumflex Iliac Perforator Flap

It is believed that skin flaps should not be used to reconstruct large scrotal defects because thick flaps increase testicular temperature and decrease fertility, and those skin grafts should be used to reconstruct large scrotal defects. We report a case of extensive scrotal defect reconstructed with bilateral superficial circumflex iliac perforator (SCIP) flaps in which spermatogenesis improved postoperatively over time. A 44-year-old man underwent reconstruction of an extensive scrotal defect caused by Fournier gangrene, and bilateral SCIP flaps were used for the reconstruction. In the third postoperative month, his semen volume and sperm count after centrifugation were 1.5 mL and eight, respectively. Based on these semen findings, fertility specialists diagnosed the patient with extremely low fertility. In the ninth postoperative month, the semen volume was 2.2 mL, sperm density was 2.7 × 10⁶/mL, sperm motility was 64%, and normal sperm morphology was 54%, indicating significant improvement. Based on the sperm findings, fertility specialists considered the patient capable of causing pregnancy. There have been no reports of preservation of spermatogenesis after scrotal reconstruction with a thinned perforator flap. In the postoperative period, we observed improvement of spermatogenesis, which suggests that scrotal reconstruction with an SCIP flap may be effective for improving both cosmetic appearance and fertility.