The aim of the study is to evaluate the surgical and functional outcomes of donor site reconstruction in a consecutive series of transgender men underwent radial artery free-flap phalloplasty (RAP). A retrospective data analysis of patients underwent a RAP from 2016 to 2021 in a national referral center was conducted. The following were set as outcome measures: pre-operative risk factors, size of the donor-site defect, the duration of the procedure, the hospital stay and the incidence of postoperative complications (<90 days). Postoperative complications were classified according to Clavien-Dindo scale. Vancouver scar scale, POSAS scale, Scar Pinch Test and aROM were used to evaluate the functional outcomes: Patient satisfaction rates were inquired using a 3 items ad-hoc created questionnaire. A sub-analysis was carried out to compare the outcomes of two different techniques: - Group A: application of a full-thickness skin graft - Group B: use of a single-layer dermal matrix with split-thickness skin graft 24 patients were included in the study. The mean follow-up was 30.2 (16.2) months. Mean age was 34.4 (14.5). Median donor site defect was 333 cc (IQR 306-323). No intraoperative complications were detected. A postoperative complication was described in 33.3% of cases: Grade 1 (20.8%), Grade 2 (8.3%) and Grade 3a (4.2%) according to Clavien-Dindo classification. Mean graft take was 88.7%. A complete graft take was detected in 41.7% of the patients with a statistically significant advantage for group B (83.3%) when compared to group A (27.8%) (p= 0.002). Functional outcomes resulted satisfactory in both groups. Overall satisfaction for arm appearance and functioning were respectively 70.8% and 87.5%. The donor-site reconstruction after radial forearm flap elevation provides satisfactory surgical, functional and aesthetic outcomes . The single-layer dermal matrix combined with a STSG may guarantee better surgical results when compared to the use of FTSG alone. None