Double-paddle use of the superficial circumflex iliac artery perforator flap for fournier's gangrene: A case report

Abstract

Fournier's gangrene often leads to extensive perineogenital soft tissue loss, necessitating complex reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap is known for its thin pliable skin and low donor site morbidity. We present a case of a 65-year-old male with Fournier's gangrene affecting both the mons pubis and scrotum. After multiple debridements, a double-paddle SCIP flap based solely on the superficial branch of the SCIA was designed with two independent skin paddles to reconstruct these adjacent but anatomically distinct areas. Preoperative CT angiography and intraoperative SPY imaging enabled flap design and ensured vascular reliability. A double-paddle SCIP flap was elevated with two skin paddles, each inset to separate regions. Through proximal-to-distal dissection, the superficial circumflex iliac artery and its superficial branch were identified and dissected. Upon confirming the origin of the arterial branching of the superficial branch, two flaps were designed-one superiorly and one inferiorly positioned-measuring 14 x 7 cm and 8 x 5 cm, respectively, with an approximate thickness of 10 mm and a pedicle length of 8 cm. The total operative time was approximately 55 min. Postoperative recovery was uneventful, with satisfactory healing and aesthetic outcome at 6 months. This case illustrates a novel use of a double-paddle SCIP flap based exclusively on the superficial branch of the SCIA to simultaneously reconstruct two separate anatomic regions affected by Fournier's gangrene. This approach provides a single-donor, dual-target solution that is both reliable and aesthetically favorable.