Pearls and pitfalls in fossa navicularis urethral reconstruction using the ventral transverse penile skin Island flap

Although typically short, strictures of the fossa navicularis present substantial reconstructive challenges related to anatomy, vascular supply, and cosmetic concerns. The ventral transverse, dartos-based penile skin island flap introduced by Jordan in the late 1980s represented a significant advancement by providing a broader and more reliably vascularized pedicle, allowing tension-free transposition compared with traditional vertically oriented penile skin island flaps. This review highlights key technical principles and common pitfalls derived from contemporary experience with the transverse ventral flap for fossa navicularis reconstruction. Essential steps include careful patient selection, complete penile degloving, wide pedicle elevation, meticulous preservation of distal penile vascularity, and tension-free glans reconstruction. Compared with buccal mucosa grafts, this approach avoids donor-site morbidity and permits management of longer, more proximal strictures with shorter recovery time. The transverse penile skin island flap remains a robust and effective reconstructive option for fossa navicularis strictures in carefully selected patients. Adherence to these technical standards ensures long-term patency and optimal functional and aesthetic outcomes, reaffirming the technique’s establishment in contemporary reconstructive practice.