K. Oben, A. Zarowska, L. De Roeck, I. Vrints
Department of Plastic Surgery, Heilig Hart Ziekenhuis, Lier, Belgium
Summary
Background: Fournier’s gangrene (FG) is an acute polymicrobial necrotizing fasciitis of perineal, perianal, or genital areas that requires immediate intervention, due to its potential life-threatening outcome. The surgical treatment often consists of aggressive debridement, requiring soft tissue reconstruction in a challenging area after infection control. Case description: In this report, we discuss the case of a 34-year-old man, presenting with painful scrotal swelling and fever 48 h after a vasectomy. He was diagnosed with FG of both the scrotum and penile shaft. After infection control, the soft tissue reconstruction consisted of a bilateral superomedial thigh flap for scrotal reconstruction, and MatriDerm skin substitution with full sheet skin grafting for the penile defect. Discussion: Since FG is a rapidly progressive disease with a high mortality rate, early diagnosis and treatment remain essential factors in the management of this disease. After the initial treatment, which consists of fluid resuscitation, extensive surgical debridement and the administration of antibiotics, reconstructive surgery is necessary for covering the soft tissue defect. A wide range of reconstructive techniques exist, including skin grafting, local advancement flaps, multiple fasciocutaneous and myocutaneous flaps, and testicular transposition. The superomedial thigh flap, which receives blood flow from many sources, is a sensate flap with easy dissection and a short operative time. It has many other advantages, including the possibility of rapid planning and obtaining an aesthetically pleasing result, as well as a low reported incidence of flap failure. Conclusions: The reconstruction of soft-tissue defects following FG can be challenging. Due to the commonly compromised general condition of the patients, the chosen treatment strategy must prioritize rapidity and minimal procedural risk, while also addressing aesthetic outcomes, functional restoration, and minimizing patient morbidity. We believe a superomedial thigh flap meets these requirements and should therefore be taken into consideration for the reconstruction of tissue defects following FG.
Key words
Fournier’s gangrene – scrotal reconstruction – superomedial thigh flap – soft-tissue defects – reconstructive surgery
Oben K, Zarowska A, De Roeck L et al. Reconstructive challenges following Fournier’s gangrene: a case report. Acta Chir Plast 2026; 68 (1–2): 56–62.