Pedicled Gracilis Flap for Scrotal Reconstruction Following Fournier’s Gangrene. Literature Review and Technical Notes.

Background: Scrotal reconstruction is needed in response to multiple conditions, such as Fournier’s Gangrene. In this scenario, thorough debridement is necessary in order to achieve definite healing, the next step being scrotal reconstruction, for which a search for optimal aesthetic and functional outcomes should be the norm. In the authors’ experience, the bilateral pedicled gracilis flap allows for the meeting of these standards.Objective: To revise the published literature on scrotal reconstruction using pedicled gracilis flaps after Fournier’s Gangrene, collecting data on defect size, reconstructive method and complication rates, followed by a detailed description of the technique, in which the authors share some technical notes and present a one-year follow-up case.Design, setting and participants: We conducted a systematic review on the published literature following PRISMA2020 recommendations, which yielded 9 studies. We analyse them for collection of previously defined variables and share the case of one patient, in order to compare our experience with the published literature.Results: Nine studies including 30 patients were analysed in our review. The mean age was 45.99 and mean defect size 12.25 cm x 11.5 cm. For 16 of these patients, a musculo-cutaneous flap was used, whereas in the other 14 muscle flaps were elevated and then grafted. There were no reports of flap failure or major complications in any of the studies.Conclusions: The pedicled gracilis flap is an excellent option for scrotal reconstruction following Fournier’s Gangrene. It provides optimal coverage and allows for a functional and aesthetic reconstruction.