Complex Scrotal Reconstruction in Fournier's Gangrene Using a Two-Stage Delayed Bilateral Medial Thigh Skin Flap...

Fournier's gangrene is a rapidly progressive necrotizing soft tissue infection that can cause extensive scrotal loss and requires durable reconstruction with acceptable contour and function. A 54-year-old man presented 4 weeks after emergent perineoscrotal debridement with complete scrotal skin loss and exposed testes. Reconstruction was performed using a two-stage approach. In Stage 1, each testis was placed into a medial thigh subcutaneous pocket beneath thin skin to encourage neovascularization. In Stage 2, delayed bilateral medial thigh skin flaps were elevated and advanced to the midline to create a neoscrotum. Minor donor-site wound dehiscence was managed locally. A two-stage delayed bilateral medial thigh skin flap can provide reliable, thin coverage and a natural neoscrotal contour after total scrotal loss.