Between January 1983 and September 1992, 32 myocutaneous flaps were fashioned in 28 patients for reconstruction following treatment of genitourinary malignancies or complex pelvic fistulas. Of the myocutaneous flaps 14 were used to obtain primary soft tissue coverage of large but otherwise uncomplicated wounds and 10 were used to cover previously irradiated resection sites. Four myocutaneous flaps were used to repair complex radiation-induced fistulas involving the bladder, vagina, urethra and rectum. Flaps were used to cover infected or nonhealing open wounds in 8 cases, 4 of which also had been previously irradiated. Myocutaneous flap donor sites were the tensor fascia lata in 11 cases, gracilis in 9, rectus abdominis in 10 and rectus femoris in 2. There was 1 major complication (flap loss) and 9 minor complications. There were no perioperative deaths. Myocutaneous flaps are an effective means of covering large groin, perineal and lower abdominal surgical defects after radical surgery.