摘要Background Phalloplasty is still a challenging operation because of the high urethral complication rate. Several options regarding different flaps can be chosen, but there is still no perfect solution for phalloplasty in female-to-male (FTM) transgender patients. Our group tried to use prefabricated anterolateral thigh (ALT) flaps for phalloplasty to overcome the urethral complications. Methods A total of 21 transgender patients were included from 2010 to 2019. A two-stage operation was performed to reconstruct the phallus. The vaginal mucosa was prefabricated as neourethra at the first stage, and the shaft of the phallus was reconstructed at the second stage. Results All reconstructed phallus survived completely in our study, and the satisfaction rate was 76.2％. The total complication rate was 57.1％. The occurrence of fistula and strictures after the operation was 52.4％ and 5.8％, respectively Conclusion Prefabricated ALT flaps with vaginal mucosa have a lower stricture rate. This technique provides a simple, effective surgical option in FTM transsexuals.