Fournier’s gangrene, a fulminant necrotising fasciitis of the perineum and external genitalia, often necessitates extensive debridement that leaves significant scrotal soft-tissue defects. Reconstruction aims to achieve durable coverage of the testes, preserve function, and restore acceptable cosmetic appearance, but there is no universally accepted reconstructive standard. A review of the literature reveals a spectrum of reconstructive strategies tailored to defect size, depth, and patient comorbidity (Karian et al. 2015). Small defects (<50% of the scrotal surface) may be managed with scrotal advancement flaps or healing by secondary intention, avoiding tension on closure (Karian et al. 2015; et al. 2010). Skin grafting remains a widely used and relatively simple option, providing reliable coverage with satisfactory wound healing in many cases, particularly when testicular exposure is present without deep cavitation. For larger or more complex defects, locoregional flaps offer robust soft-tissue coverage. Medial and superomedial thigh fasciocutaneous flaps have demonstrated favourable outcomes with texture and colour match similar to native scrotum (Karian et al. 2015; et al. 2023), while pedicled gracilis muscle or myocutaneous flaps provide well-vascularised tissue and resistance to infection for extensive defects (Ilori et al. 2021; Karian et al. 2015). Pedicled anterolateral thigh (ALT) perforator flaps have also been reported to yield satisfactory contour and function for large perineoscrotal losses (Kim et al. 2014). Other reconstructive options described include pudendal thigh and medial circumflex femoral artery perforator flaps, each with specific indications based on defect characteristics and surgeon expertise. Although most techniques yield acceptable protective coverage and preserve testicular viability, comparative data remain limited and heterogeneous. Choice of method should be guided by defect extent, patient factors and resource availability, balancing surgical complexity with functional and aesthetic outcomes.