INTRODUCTION
Fournier’s gangrene is a rare, rapidly progressive, fulminant form of necrotizing fascitis of the genital, perianal and perineal regions.1 It is characterised by progressive spread of necrosis in the skin and subcutaneous tissue combined with severe systemic infections.2 It is a polymicrobial infection and is caused by both aerobic and anaerobic bacteria which further leads to thrombosis of subcuatneous and subcutaneous blood vessels, resulting in severe gangrene.3 Any trauma or infection in the perineal region or urinary tract forms the initial focus of disease.4 In general, the infection occurs in immunocompromised patients such as diabetic, HIV seropositive, alcoholic and elderly individuals. Patients who are undernourished and from low socioeconomic strata are
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Anatomical basis of the flap
The medial thigh flap is based on septocutaneous branch of femoral artery. The axis of the flap is a line joining the apex of the femoral triangle and 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 edge of adductor longus and the medial edge of rectus femoris muscle makes the lateral border of flap.12
Surgical technique
All patients were operated under general anaesthesia with orotracheal intubation in lithotomy position. The axis of the flap was a line joining apex of femoral triangle to the medial femoral condyle. The dominant pedicle was located at the apex of the femoral triangle around 6-8 cm below the inguinal ligament and it was detected preoperatively by Doppler examination. The width of the flap ranged from 7-11 cm whereas the length ranged from 15-25 cm. Dissection was done distal to proximal in the subfascial distal plane over the muscle. After harvesting flap was rotated to cover the testicular and perineal area and creating a scrotum with tension free