In the course of treating more than 700 patients at a center that sees most of the malformative pathology of central and southern Italy (Ospedale Bambino Gesù of Rome), we devised and refined a technique for the repair of hypospadias. It involves use of the external leaf of the prepuce for reconstruction of the missing urethral canal. Careful dissection of the neurovascular bundle of the dorsum of the penis that nourishes the isolated flap of preputial skin renders the flap completely mobile. The concept if island flaps is well known in plastic surgery for lesions in other areas, but we do not believe it has yet been applied in the treatment of hypospadias. The one-stage island flap technique is described and its application discussed in the various forms of hypospadias.