Single-Stage Reconstruction of Extensive Defects after Fournier's Gangrene with an Exposed Iliac Crest and Testes

pattern flap that consists of perforators of three arteries: the external pudendal, superficial femoral, and medial circumflex femoral arteries. The presence of axial vessels from the medial femoral circumflex artery and vein has been demonstrated by transillumination at the time of surgery and by cadaveric study [2,3,5]. Because of the longitudinal axial interconnections of these three vessels above the deep fascia of the medial thigh, preservation of only the proximal afferents of each pedicle allows for safe elevation of this large, longitudinally-oriented medial thigh fasciocutaneous flap [3]. With this anatomical understanding, the flap can be medially rotated approximately 90 degrees at the lithotomy position, while preserving the axial vessels, to cover the defect. We thought bilateral flaps could maintain the scrotal shape aesthetically better than other unilateral flaps. Compared to other cases of unilateral flap coverage, the midline scar after bilateral flap insertion can substitute for the perineal raphe aesthetically. With thin fasciocutaneous flap coverage, the contour of the reconstructed scrotum looks similar to a normal scrotum. After flap elevation, the donor site can be closed by primary intention without excessive tension. Aesthetically, the inner part of the thigh is relatively unexposed. In conclusion, bilateral medial thigh fasciocutaneous flap is a safe and effective procedure in perineoscrotal reconstruction without donor site morbidity for both small and large defects.