Introduction: Fournier‘s gangrene (FG) is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions, which commonly affects men, but can also occur in women and children¹. Scrotal raw areas are a source of morbidity and of great concern to the patients inflicted with this problem. Most of the cases of scrotal raw area are seen as a result of diabetic patients who develop Fournier’s gangrene and require radical debridement. Fournier’s gangrene is usually a consequence of a polymicrobial infection with E.coli (aerobic), bacteriods (anaerobic) and streptococci (aerobic and anaerobic)².

Materials and Methods: This case series is intended to present the results of scrotal reconstruction in 3 cases of Fournier gangrene case of using Singapore flaps and it was compared with other cases to review the outcome and recommendation for future use. A total of 03 patients were included in this study. All patients were male, with total or near total scrotal defects following debridement of Fournier’s gangrene. Two patients had near total scrotal defects and one patient had total scrotal defects. Bilateral pudendal thigh flaps (Singapore flaps) were used to reconstruct the scrotal defects in all cases.

Results: Triple antibiotic combined with radical debridement is the mainstay of treatment. There have been many advances in management of Fournier gangrene including use of vaccum assisted closure and hyperbaric oxygen therapy. Bilateral pudendal thigh flaps (Singapore flaps) is now giving promising result in such cases. The flap survival rate was found to be 100% in all cases and none of the postoperative patients required revision of the flap. At the one month postoperative visit, all patients presented with stable, viable flaps. All flaps proved to be exceptional color matches to the surrounding tissue and demonstrated excellent pain and light touch sensation. All patients reported high levels of satisfaction in regards to the esthetic appearance as well as the functionality and sensation of their new scrotum. Reconstruction of perineal defects using skin grafts, flaps, and urethral reconstruction using gracilis flaps can reduce the morbidity associated with FG and provide acceptable functional and aesthetic outcomes.

Conclusions: Singapore flap reconstruction is a very versatile technique and can be achieved as a single stage procedure. We have concluded that the Singapore flap is a superior choice in scrotal defect coverage and reconstruction due to the excellent clinical results as well as the patient’s satisfaction in regards to the procedure outcome