KUWAIT MEDICAL JOURNAL 293 December 2008 INTRODUCTION Perineoscrotal (Fournier’s) gangrene is a rare potentially fatal clinical entity [1] . It is characterized by progressive spread of necrosis in the skin and subcutaneous tissue combined with severe systemic infection [2] . Following aggressive surgical debridement, major scrotal and perineal defects with exposed testes are a challenge for reconstructive surgeons [3,4] . Numerous techniques have been described for reconstruction of these defects including split thickness skin grafts [5,6] , muscle flaps (e.g., Gracilis flap [7,8]) and fasciocutaneuos flaps (e.g., pudendal flap [9,10] , perineal flap [11] and anterolateral thigh flap [12] ). This study presents the author’s experience of using the medial thigh flap for coverage of scrotal and perineal defects after debridement of Fournier’s gangrene. PATIENTS AND METHODS Between July 2005 and October 2006 at Al-Babtain Center for Burns and Plastic Surgery medial thigh flap was performed in seven male adult patients. ABSTRACT Objective: To study the versatility, aesthetic and functional outcome of medial thigh flap for coverage of large perineoscrotal defects Design: Prospective Setting: Al-Babtain Center for Burns and Plastic Surgery (State Government Institute) Subjects: Seven patients with Fournier’s gangrene seen between July 2005 and October 2006 at Al-Babtain Center for Burns and Plastic Surgery Intervention: Reconstructive surgery for coverage of scrotal and perineal defects after debridement of Fournier’s gangrene. Nine medial thigh fasciocutaneuos flaps were performed under general anesthesia. Main Outcome Measures: General aesthetic and functional results in the form of the range of motion of both hip joints. Results: All flaps survived well with good aesthetic and functional results, with the exception of partial distal necrosis in two cases. This was managed conservatively in one case, while the other case needed debridement and minimal advancement of the flap. Conclusion: The medial thigh fasciocutaneuos flap offers a good option for coverage of perineoscrotal defects. The flap provided a single stage, stable, well vascularized soft tissue coverage in our patients with no significant complications. KEY WORDS: fasciocutaneuos flap, Fournier’s disease, medial thigh Original Article The Versatility of the Medial Thigh Flap for Coverage of Large Perineoscrotal Defects Address correspondence to: Dr. Hisham Burezq MD FRCSC FAAP, PO box 1574, Mishref 40179, State of Kuwait. F (965) 2562-6020, E-mail: burezq@msn.com Kuwait Medical Journal 2008, 40 (4): 293-296 Ahmad Al-Fadhli, Hisham Burezq, Nabeel Abdulfattah, Wael Ayad Department of Plastic and Reconstructive Surgery, Al Babtain Center for Burns and Plastic Surgery, Sabah Health Center, State of Kuwait Their mean age was 42 (range 33 - 52 years). All patients presented with soft tissue defects of the scrotal and perineal areas after extensive multiple debridement sessions for Fournier’s gangrene. Broad spectrum systemic antibiotics were given and continued for five days postoperatively. Nine medial thigh fasciocutaneuos flaps were performed (five unilateral and two bilateral). Patients were followed for 3 -18 months postoperatively. Anatomical basis of the flap: The medial thigh flap located along the medial aspect of the thigh, is based on a septocutaneous branch of the femoral artery at the apex of the femoral triangle. The axis of the flap extends from the apex of the femoral triangle toward the medial femoral condyle. The skin territory of the flap extends from the inferior aspect of the femoral triangle to the junction of the middle and distal thirds of the medial thigh. The lateral borders of the flap are located between the lateral edge of the adductor longus and the medial edge of the rectus femoris muscle.