Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 5 2025 04 26 208 211 Hosseinali Abdolrazaghi Hand & Reconstructive Surgery Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hossein Zabihi Mahmoudabadi Minimally Invasive Surgery Department, of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Alireza Naghdipur General Surgery Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hojjat Molaei Plastic & Reconstructive surgery Department, Imam Khomeini Hospital Complex, of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2024 12 26 2025 02 02 Inguinal hernia repair is a common surgery that can result in incarceration in some cases. Catastrophic events may be encountered in specialized circumstances, such as Fournier’s gangrene, which is an emergent condition. Treatment of debrided skin of the abdominal wall is always challenging, particularly in large defects. A 69-year-old man suffered from complications following inguinal hernia repair, which included laparoscopic mesh repair, subsequent right hemicolectomy with anastomosis, leading to ileostomy, Fournier’s gangrene, and eventually a large skin defect in the lower abdomen and perineal area. After multiple sessions of wound therapy, he underwent abdominal wall reconstruction with two large pedicled anterolateral thigh flaps. Anterolateral thigh flaps, with their robust blood supply, can easily reach the lower abdomen and cover extensive abdominal skin defects when transferred bilaterally. Level of Evidence: Level V, therapeutic study https://crcp.tums.ac.ir/index.php/crcp/article/view/1011 https://crcp.tums.ac.ir/index.php/crcp/article/download/1011/686