Neoadjuvant chemoradiation followed by abdominoperineal resection (APR) or pelvic exenteration (PE) is the standard treatment for locally advanced rectal and gynecologic malignancies [1]. The resultant defect combined with radiotherapy is associated with high complication rates including wound infection, pelvic floor dehiscence, and hernias [2, 3]. Vertical rectus abdominis myocutaneous (VRAM) flaps provide vascularized non-irradiated tissue that can fill these large voids, thus reducing wound complications [4, 5]. Multiple studies describe the VRAM as the main workhorse flap, consistently boasting superior results compared to thigh-based flaps [6, 7].