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The diagnosis of Fournier's gangrene is essentially clinical. Clinical features include sudden onset of genital or perineal pain and swelling, fever and prostration with progression to tissue necrosis with purulent discharge, crepitus or fluctuation and septic shock [2, 5]. Imaging studies such as plain abdominal x-ray, ultrasonography, computed tomography (CT) or magnetic resonance imaging (MRI) may be helpful in early diagnosis or atypical presentations and in evaluating the extent of the disease by revealing thickening of the scrotal wall and presence of gas in subcutaneous tissue [1, 3, 5]. CT is the most specific imaging study for diagnosis and can also aid in preoperative planning and investigation of the underlying causes [1, 3]. Bacterial culture often isolates multiple organisms, including anaerobes and aerobes [1, 2, 3]. Early diagnosis and treatment are essential in the management of Fournier's gangrene, with intensive

The SCAIF has unique features that makes it an ideal option for pharyngocutaneous and tracheoesophageal fistula closure, namely, reliable perfusion, quick and simple dissection, pliability and minor donor site morbidity. Local complications do not significantly affect long term morbidity of the donor area and can be avoided with simple measures.