Management of Fournier's Gangrene Defects: A Retrospective Surgical Case Series of 23 Patients and review of Surgical Strategies

Fournier's Gangrene (FG) is a fulminant necrotizing fasciitis that necessitates immediate, aggressive surgical debridement to ensure patient survival. This life-saving measure often results in extensive soft-tissue defects of the genitoperineal region, posing a significant reconstructive challenge. This study reviews the surgical strategies and outcomes for reconstructing these complex defects in a high-risk patient cohort. A retrospective study was conducted on 23 consecutive patients (22 men, 1 woman) who underwent reconstruction for FG defects at the plastic and reconstructive surgery department in Tangier, Morocco, from March 2021 to October 2025. We analyzed patient demographics, comorbidities, defect characteristics, timing of reconstruction, and the surgical techniques employed. The mean patient age was 58.1 years. Diabetes mellitus was the most prevalent comorbidity, affecting 15 patients (65.2%). Patients required a mean of 2.8 debridement’s, and the mean time from final debridement to reconstruction was 35.5 days. The most common defects involved the scrotum and perineum (43.5%). Split-Thickness Skin Grafts (STSG) were the most frequently used reconstructive method (14 patients, 60.9%), followed by healing by secondary intention (7 patients, 30.5%) and scrotal advancement flaps (2 patients, 9.6%). The overall postoperative complication rate was 17.4% (4 patients) and included minor issues such as partial graft loss and partial flap necrosis, which were managed successfully. Successful reconstruction of Fournier's Gangrene defects relies on a flexible, defect-based algorithm rather than a single "best" technique. Our findings confirm that STSG is a safe, reliable, and effective modality for covering large defects, particularly in comorbid patients. Scrotal advancement flaps remain a viable option for smaller defects limited to scrotum. This individualized approach is essential for minimizing morbidity and achieving durable wound coverage.