In the USA, external beam radiation is offered to patients as an alternative to surgery for non-melanoma skin cancers. While this technique may be useful in highly specific patient populations, recalcitrant chronic radiation wounds can result. These complex wounds ultimately may require major reconstructive surgery to achieve closure. Porcine urinary bladder matrix (UBM) may be effective in the treatment of radiation wounds and eliminating the need for vascularized tissue transfers. A case report of an elderly male with bilateral radiation wounds of the lower extremity, one extremity treated with free flap reconstruction and the other with porcine urinary bladder matrix, is presented.