Abstract Introduction Phalloplasty is a surgical procedure aimed at the construction of a neophallus in transgender male patients. Although the forearm free flap technique is considered the gold standard in many centers, its high complication rate has motivated the search for alternatives. This study evaluates the results of phalloplasty using the suprapubic abdominal randomized flap, associated with scrotoplasty and, in many cases, an annexohysterectomy and colporrhaphy in the same surgical setting. Objective To contribute to medical knowledge in the field of transgender surgery, offering valuable information that may improve clinical decision-making and optimize surgical protocols. To evaluate the surgical, functional, and aesthetic outcomes of phalloplasty using the randomized abdominal flap, as well as the incidence of complications. Methods A retrospective observational study based on the review of clinical records of transgender male patients who underwent phalloplasty with the abdominal flap between November 2015 and May 2025. Forty-five patients who met the inclusion criteria were included. Surgical, functional, aesthetic variables, and the incidence of complications were analyzed. Results The technique showed a low rate of intraoperative and immediate postoperative complications, with no need for transfusions. Late complications were infrequent and, for the most part, associated with scarring or aesthetic defects, which were surgically correctable. The average surgical duration was 4 hours, with controlled bleeding and a hospitalization time of 4 days. The mean follow-up was 44 months. Conclusions Phalloplasty with the randomized abdominal flap, associated with scrotoplasty and annexohysterectomy, constitutes a safe, effective, and reproducible surgical option. It presents a low complication rate, with good aesthetic and functional results. Long-term follow-up is fundamental for the timely detection and treatment of late complications. Disclosure No
Belinky et al. (Mon,) studied this question.
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