A Novel Single-stage Technique for Ventral Penile and Urethral Reconstruction Using a Deep External Pudendal Artery Propeller Flap.

Reconstruction of the penile shaft represents a complex surgical challenge, especially when both cutaneous and urethral components are involved. Although total phallic reconstruction is well established, partial ventral penile defects lack standardized treatment strategies, particularly in older or multimorbid patients unfit for microsurgical procedures. We present the case of a 78-year-old man with a 2.5 × 3.5 cm full-thickness ventral shaft defect and associated urethral involvement, secondary to Fournier gangrene. A 3.0 × 5.0 cm freestyle propeller flap based on the deep external pudendal artery was designed and harvested. Urethral continuity was restored by suturing a buccal mucosal graft to the internal surface of the flap. The procedure was performed without microsurgical anastomosis, using a minimally invasive approach suitable for high-risk surgical candidates. The postoperative course was uneventful, with spontaneous resolution of minimal venous congestion. At 12-month follow-up, the patient demonstrated complete recovery of normal urinary function, excellent aesthetic results of the penile shaft, and stable flap viability with preserved urethral patency. The deep external pudendal artery-based propeller flap offers a reliable, reproducible, and low-morbidity solution for partial penile shaft reconstruction, combining functional and cosmetic restoration. This technique represents a valuable alternative for patients at high surgical risk who are not candidates for microsurgical phalloplasty. Further anatomical and clinical studies are needed to consolidate its indications.