A dartos-based transverse skin flap for ventral penile skin coverage is used as an adjunct to hypospadias surgery. The technique is simple and reliable. After completing the primary repair of the penis, the ventral skin defect is assessed. A dartos pedicle is developed, and the flap of dorsal penile skin is transferred ventrally along either side of the shaft. To date, 63 boys (ages 6 to 78 months) have undergone this type of penile skin reconstruction. Our transverse preputial flap has been used as an adjunct to hypospadias repair (28 boys), correction of chordee (26 boys), and release of concealed penis (9 boys). During a follow-up period of 6 to 74 months, 52 patients (83%) had a favorable cosmetic result. One patient experienced a significant loss of epithelium in the early postoperative course. Another patient developed a moderate penile torsion, which required subsequent revision of the repair. Two patients developed moderate scar indentations of the repair. Seven patients demonstrated a moderate redundancy of the flap with time. The transverse preputial flap is a reliable and cosmetically superior alternative to ventral skin coverage in hypospadias surgery, repair of chordee, and in the release of concealed penis.