Background <p>Deep-pelvic Fournier’s gangrene (FG) spreading via supralevator abscesses is a rare yet clinically challenging condition, often requiring meticulous surgical intervention to ensure adequate drainage while avoiding critical anatomical injury. Although combined suprapubic and transsacral approaches for extraperitoneal compartment access and linked-loop drainage systems represent innovative strategies, their efficacy and outcomes remain underreported. This study aimed to analyze the clinical outcomes of patients with deep-pelvic Fournier gangrene treated using this dual-approach technique.</p> Methods <p>This observational retrospective study included nine patients diagnosed with deep-pelvic FG complicated by extraperitoneal extension across three tertiary medical centers (January 2015–August 2024).</p> Results <p>Data from nine patients, including age, sex, body mass index, and comorbidities, were extracted and analyzed. All of the patients were successfully drained by the combined suprapubic and transsacral approach. No postoperative morbidity and secondary debridement occurred. During the follow-up period, 3 patients developed anal fistulas, which were subsequently treated with fistulectomy.</p> Conclusion <p>The combined suprapubic and transsacral approach demonstrated high procedural success and favorable healing outcomes in treating deep-pelvic FG.</p>