Scrotal Reconstruction Using Bilateral Fasciocutaneous Thigh Pouches After Debridement for Fournier's Gangrene: A Case Report

Abstract

We report the case of a 64-year-old male who presented with progressive bilateral scrotal swelling, pain, fever, and local discomfort. Clinical examination revealed diffuse scrotal edema, erythema, and areas of necrosis. Laboratory investigations showed marked leukocytosis (25,800 cells/mm³), while ultrasonography demonstrated bilateral epididymitis, funiculitis, and diffuse scrotal wall edema. A diagnosis of Fournier’s gangrene was established, and the patient underwent emergency surgical debridement. Intraoperative findings included extensive necrosis of the superficial and deep fascial layers with foul-smelling necrotic fluid and slough formation. Following infection control and development of healthy granulation tissue, definitive reconstruction was performed using bilateral fasciocutaneous thigh pouches. The testes were transposed into bilateral medial thigh pockets, and the remaining viable scrotal tissue was approximated to provide adequate coverage.The postoperative period was uneventful. The patient demonstrated satisfactory wound healing, preservation of testicular viability, and no evidence of recurrent infection or reconstructive complications. Follow-up evaluation showed good functional recovery and an acceptable cosmetic outcome.