The Usefulness of DEPAP Flaps for Reconstructing Perineal Defects Caused by Fournier's Gangrene: A Case Report

Background: Fournier's gangrene is a rare and aggressive form of necrotizing fasciitis involving the perineal, genital, and perianal regions. Despite advances in critical care, early diagnosis and rapid surgical intervention remain crucial to reduce mortality and morbidity. Extensive debridement often leads to complex perineal defects that require reliable reconstructive options. This study presents a case highlighting the usefulness of the deep external pudendal artery perforator (DEPAP) flap in perineal reconstruction following Fournier's gangrene. Methods: A 43-year-old male patient developed Fournier's gangrene secondary to underlying colon cancer scheduled for chemotherapy. Following wide excision and serial debridement to remove necrotic tissue, reconstruction was performed using a DEPAP flap designed from the upper medial thigh region. The flap was elevated based on perforators identified by a handheld Doppler and rotated to cover the perineal defect. Results: The flap survived completely without any vascular compromise or wound complications. The patient achieved satisfactory functional recovery with stable wound healing and an acceptable cosmetic outcome. No recurrence or contracture was observed during the 9-month follow-up. Conclusions: Fournier's gangrene associated with underlying colon cancer and subsequent chemotherapy presents additional challenges due to impaired wound healing and increased infection risk. In such complex cases, the deep external pudendal artery perforator (DEPAP) flap offers a reliable single-stage reconstructive option that ensures durable coverage, rapid recovery, and minimal donorsite morbidity. Our case demonstrates that even in immunocompromised or oncologic patients, the DEPAP flap provides stable wound healing and satisfactory functional and esthetic outcomes, supporting its usefulness in managing perineal defects after oncologic Fournier's gangrene.