Background: Fournier gangrene is an acute and potentially lethal necrotising fasciitis that involves the scrotum and perineum. This disease can result in the loss of skin and soft tissue. Multiple options for reconstruction of the scrotum are available. To repair the scrotal and perineal defects remains a surgical challenge. Objective: The aim of this work is to compare different modalities of reconstruction in Fournier gangrene and to verify the indications of efficacy of each modality. Patients and methods: The present study includes 20 patients with diagnosis of Fournier gangrene from the General Surgery Departments, Faculty of Medicine, Zagazig University Hospitals from 2010 to 2012. Following admission, correction of the fluid and electrolyte imbalance, and estimation of the extension and depth of the gangrenous area were done. After stabilization of the patients, all patients underwent surgical debridement with frequent dressing, and then the patients were divided randomally into four groups according to the reconstructive procedure. Results: A total of 20 cases with Fournier gangrene were included in this study. All patients included in this study were males. Their age ranged from 20–70 years old with a mean age of 50 years. The most common comorbid condition was diabetes mellitus in 50% of cases. The infection was polymicrobial in 70% of cases. Wound healing with secondary repair was performed in 5 patients. Wound healing with primary closure was performed in 5 patients. Wound healing with split-thickness skin graft was performed in 5 patients. Wound healing with gracilis muscle flap followed by split-thickness skin graft was performed in 5 patients. No surgical mortality was recorded. Conclusion: Gracilis muscle flap plus split-thickness skin graft covered the deep perineal defects very well. It is a reliable procedure, which provides excellent cover for the exposed testes and gives satisfactory protection and aesthetic outcome.