Testicular lodges creation during scrotal reconstruction by ALT (anterolateral thigh) island flap after Fournier gangrene: A case report.

Introduction: Fournier's gangrene is a severe infection of the perineum and genital regions, with high mortality rate. Treatment is medico-surgical and multidisciplinary, usually requiring extensive debridement of scrotal tissue and distant surgical reconstruction. Regarding scrotal reconstruction, numerous techniques have been described, however, to our knowledge, none has focused on testicular repositioning.

Case: We present the case of a 47-year-old patient treated for secondary Fournier's gangrene on post-traumatic colic fistula following a road traffic accident. We performed scrotal reconstruction using an ALT flap, with simultaneous positioning of testicular implants to create new lodges. In a second time, the testicular implants were removed and the previously buried testicles were repositioned in their new lodges, with bilateral orchidopexy.

Discussion: The anterolateral thigh flap has already been described for scrotal reconstruction. Its main advantages over a thin skin graft are partial innervation and more convincing aesthetic results, with notably less skin retraction. In addition, it allows a sufficiently large skin palette to be harvested, enabling satisfactory scrotal coverage.

Conclusion: Placement of 2 testicular implants during scrotal flap reconstruction after Fournier's gangrene enables the creation of testicular lodges, facilitating subsequent repositioning of previously buried testicles. This technique also ensures a satisfactory aesthetic and functional result.