Reconstruction of complex urethral defects should provide lasting coverage, a patent tube for voiding, and a natural appearing contour with minimal morbidity to the donor and recipient sites. Many reports have emerged in the literature regarding complex urethral reconstruction through a variety of methods including anterolateral thigh flaps, radial artery forearm free flap, and other simple skin and mucosal flaps. Recently, Ozkan and Ozkan reported using a prefabricated anterolateral thigh flap for reconstruction of a traumatic urethral defect (Ozkan and Ozkan, J Plast Reconstr Aesthet Surg. 2009;62:380-384). In this report, we describe our experience with the use of a prefabricated gracilis muscle flap in a female-to-male transsexual with a complex proximal urethral stricture and distal fistula. We believe this is the first report of a prefabricated gracilis myocutaneous muscle flap being used for a long segment urethral stricture and distal fistula. We believe that this procedure offers a unique solution to a difficult problem with decreased morbidity and cosmetic advantages over other methods requiring microvascular anastomoses.