Perineal Reconstruction with Thick Split-Thickness Skin Grafts following Fournier’s Gangrene and Traumatic Perineal Degloving Injury: A Case Report

Background: Perineal reconstruction following extensive soft tissue loss presents a formidable surgical challenge, particularly in resource-limited settings where advanced reconstructive options may not be readily available. Both Fournier’s gangrene and traumatic degloving injuries can leave large perineal defects that demand reliable, cost-effective, and technically accessible solutions. Case Presentation: The authors report two adult male patients managed at two major referral centres in Ghana. The first was a 67-year-old hypertensive farmer who presented with circumferential penile and scrotal wounds secondary to Fournier’s gangrene. After serial debridement and wound optimisation, we reconstructed the penile shaft with a thick split-thickness skin graft (TSTSG), while the scrotal defect was closed primarily, with 100% graft take on post-operative day 10 and satisfactory functional recovery at eight weeks. The second was a 28-year-old farmer who sustained a complete perineal degloving injury in a road traffic accident. After three weeks of wound bed preparation, the scrotum was reconstructed with bilateral random cutaneous thigh flaps and the penile shaft with a TSTSG, with full wound healing at three months and preserved penile sensation and erectile function. Conclusion: Thick split-thickness skin grafting, used alone or in combination with local flaps, is a practical, reliable, and reproducible reconstructive strategy for complex perineal defects in low-resource settings. These cases support its broader adoption as a first-line option when free flaps or specialised tissue-engineering modalities are unavailable.