Surgical cure demands adequate disease-free margins. Since large debulking procedures are often necessary, reconstructive techniques must be available for the completion of therapy. Several different techniques can be used for the reconstruction of the pelvis and perineum. The rectus abdominis muscle flap is a very versatile flap, useful in covering many defects. It is highly reliable, with a consistent vascular supply and muscular development. The gracilis flap has been popular for many years for vaginal reconstruction, but it is somewhat less reliable. The pudendal thigh flap is relatively simple and has the distinction of being at least partially sensate. The final two flaps described here are the simplest but no less useful: the bulbocavernosus flap is particularly suitable for obstetric as well as oncologic defects on the vesicovaginal and rectovaginal septa; while advancement flaps may be the easiest of these techniques and the most often used to release tension on many different incisions.
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