A Technique for Improving Cosmesis after Primary Scrotum Reconstruction with Skin Grafts

The purpose of this report was to present a 2-step approach for treating near-total scrotal defects after Fournier gangrene, which proved to be safe, reliable, and with improved cosmesis. The first step involves a wrap-around skin grafting, whereas the second step involves reapproximation of the previously skin-grafted testes and shaping the neoscrotum to optimize cosmesis. The previously mentioned technique was performed in 6 patients with total scrotal defects after Fournier gangrene. The mean follow-up was 18 months. Primary closure was achieved in all patients. After the second step of the reconstruction, satisfactory cosmetic and functional outcomes were achieved. Specifically, scrotal volume was considered adequate without testicular compression in all cases. The proposed technique is indicated for scrotal defects with total skin loss involving exposed testes. The technique is relatively simple and easily reproducible. The resulting reconstruction provides a tension-free, cosmetically appealing scrotum with complete testicular coverage. The main drawback of this technique is the fact that it is a 2-stage procedure.