Soft tissue reconstruction of traumatic or oncologic defects of the female pelvis poses several challenges. Patients with pelvic cancer often have advanced disease with prior radiation or surgical procedures that complicate reconstructive efforts. The unique gravity-dependent female pelvis is at high risk for fluid collections, external pressure, shear forces, and contamination postoperatively which can further compromise outcomes. Options for reconstruction include local, regional, and distant flaps which recruit well-vascularized tissue into the wound bed. Complications related to soft tissue reconstruction include wound dehiscence and delayed wound healing, fluid collection (hematoma, seroma), infection, partial or total flap loss, fistula, and donor site morbidity. It is essential to understand the unique risk factors for developing complications so they can be optimized during all phases of care. When complications do occur, one must be prepared to recognize and manage them effectively. The objective of this chapter is to outline methods to improve outcomes for patients undergoing reconstructive pelvic surgery.