Bilateral Trapezoid-Like Scrotal Flaps for Reconstruction of Partial Scrotal Defects after Fournier's Gangrene.

Perineal reconstruction in males can be challenging due to the complex anatomy and the potential for complications such as infection, hematoma, and wound dehiscence. In this retrospective case series, we present seven patients who underwent perineal reconstruction between 2020 and 2023 using bilateral scrotal flaps. All defects were secondary to debridement for Fournier's gangrene. In patients with defects involving up to 70% of the total scrotal surface and with sufficient intact scrotal tissue preserved superiorly and inferiorly, reconstruction was performed using bilateral trapezoid-like scrotal flaps based on perforators of the anterior and posterior scrotal arteries. The mean follow-up period was 6 months. Longer-term follow-up was not consistently available for all patients due to loss to follow-up. Nevertheless, selected cases were followed up for 1 year, as demonstrated in the clinical figures. Clinical outcomes were evaluated in seven patients enrolled in the study. The median operative time was 48 (43.5-53.5) minutes. The median length of hospital stay was 3 (2.5-4.0) days. Complete healing time was recorded as 19 (16.5-21.0) days. All flaps used for tissue coverage were successful. Among the observed complications, wound dehiscence was identified as the most prevalent, which occurred in three of seven patients (42.9%) and was managed successfully with local wound care and minor debridement. No partial or total flap loss was observed. Due to its short operating time, low donor site complication rate, and favorable tissue match, the trapezoid-like flap may represent a practical and reliable option in selected patients.