An emerging modality for Fournier’s Gangrene reconstruction: bilateral gracilis flaps with skin graft case reports

Introduction: Fournier’s gangrene often results in an extensive defect with the exposure of testes. While the initial goal of surgical management is debridement and control of infection, subsequent management involves consideration of wound closure, functional and aesthetic outcomes. We presented the technique of gracilis musculocutaneous flap with overlying split thickness skin grafting for scrotal reconstruction after Fournier’s Gangrene. Presentation of case: Two patients with Fournier’s gangrene underwent adequate surgical debridement of the scrotum and perineum. Bilateral pedicled gracilis flaps were raised by designing a skin incision over the upper half of the medial thigh. The motor nerve to the gracilis was cut so as to prevent muscle contractions and promote atrophy. The testes were then covered with the transposed gracilis muscle flaps, with split thickness skin graft harvested from the lateral thigh region. Discussion: Fournier’s gangrene does not spare young men with otherwise good past health as illustrated in the cases aforementioned in this manuscript. A holistic surgical management would include disease control, cosmetic result and functional outcomes. For better cosmesis and long-term psychosexual satisfaction, bilateral pedicled gracilis myocutaneous flap is an option for reconstruction, resembling a natural scrotum with thin cremasteric muscle and overlying skin with a scrotal raphe. The upper medial scar can be concealed even if the patient wears shorts postoperatively. Conclusion: Bilateral pedicled gracilis myocutaneous flap with overlying split thickness skin graft offers an elegant reconstruction of the scrotum, with good patient satisfaction and good aesthetic results. This method of reconstruction should be considered as a possible option for scrotal reconstruction.