© 2021, Association of Surgeons of India.Numerous reconstructive options for scrotal and perineal defects after Fournier gangrene have been presented in the literature, from skin grafts to microsurgical transfers. In this study, we present a perforator-based V–Y advancement medial thigh flap for scrotal and perineal reconstruction. It is a microsurgical flap requiring neither microsurgical equipment nor sophisticated microsurgical techniques. Therefore, reconstruction can be performed using a simple technique and in a short time compared to conventional perforator flap surgeries. In this study, 11 patients who underwent scrotal and perineal reconstruction after Fournier gangrene using perforator-based V–Y advancement medial thigh flaps were analyzed for age, comorbidities, defect sizes, and follow-up periods. In addition, the details of three illustrative cases were provided. We found that the median patient age was 57 years, and diabetes mellitus was the most common comorbidity. All of the flaps survived, although three patients developed wound dehiscence, and one required re-suturing. While there are advantages and disadvantages of this technique, we have described the first successful use of perforator-based V–Y flaps for reconstruction after Fournier gangrene. This technique provides a practical, simple solution for scrotal and perineal reconstruction in patients with Fournier gangrene, who are generally of advanced age with comorbidities.