A pedicled transverse rectus abdominis musculocutaneous (TRAM) flap was use
d to reconstruct a large sacral defect retroperitoneally. Muscle and superi
orly located skin were elevated on the deep inferior epigastric pedicle, Th
e flap was transposed retroperitoneally from the abdominal wall to the sacr
al region of the patient, The selection criteria for this particular flap a
re discussed and compared with other reconstructive choices.