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A 16-year-old man presented to our Emergency hospital for a major traumatic scalp injury of pubic and scrotal region; this occurred as a consequence of an autonomous motorcycle accident. Early surgical esploration showed the bilateral section of spermatic cord in correspondence of the abdominal-pelvic tract; a conservative management was adopted and the patient underwent bilateral intratesticular sperm biopsy for cryopreservation. In the presence of extensive scalp injury of the pubic and scrotum skin a early surgical exploration should be performed and the multidisciplinary decision making should take in account comorbidity, age and impact on the quality of life.