Introduction: perineoscrotal defects represent a challenging problem in reconstructive surgery. Scrotal skin loss can occur following trauma, Fournier's gangrene, post tumor excision, burns, etc. There are many techniques described in the literature for reconstruction of defects of scrotal skin. The pedicled medial thigh (PMT) perforator flap is a valuable reconstructive option. In its pedicled form, the experience is currently limited to a few case reports. Objective: the purpose of this study was to describe clinical applications of the pedicled medial thigh (PMT) perforator flap for reconstruction of loco-regional soft tissue defects. Patients and Methods: between June 2018 and June 2019, an experimental cadaveric study including two cadavers with four lower limbs was done in Al-Azhar University, Faculty of Medicine, Department of Anatomy and Embryology. A prospective cross-sectional study in which ten male patients with soft tissue defects or lesions that requires excision and reconstruction in perineum and scrotum received MTP flaps. All flaps were unilateral and the flap sizes ranged from 9-12 cm to 12-26 cm. Results: all flaps survived well, with the exception of partial wound dehiscence in two patients that was managed conservatively by frequent dressings and healed by 2ry intention. Conclusion: the medial thigh fasciocutaneous perforator flap offers a good option for Perineoscrotal defects. The flap provides a single stage, stable, well vascularized soft tissue coverage with no significant major complications, short hospital stay, appropriate range of motion, faster return to normal lifestyle and accepted aesthetic appearance.