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Following APR in extensively irradiated patients with anal-and rectal cancer a TRAM flap can be used.Between 2003 and 2009, 150 APR (124 rectal-and 26 anal cancer) were performed at Ersta hospital. In 20 (12 women) cases a TRAM flap was used. The median age in those patients was 57 (35-72) years. In nine women a vaginal resection was performed. Ten anal cancers were irradiated to 64 Gy, 7-46 Gy and one patient (Mb Padget with extensive tissue defect) was unirradiated. Two rectal cancers were also irradiated and reconstructed (vaginal fistula and ugly tumor with large perineal defect).Median operative time was 508 (328-760) min and length of stay 13 (8-26) days. Seven minor perineal and four superficial abdominal wound infections were observed. Late complications were large flap (2), donor site dog's ear (1) and abdominal wall hernia (1). Three patients have died in general metastatic disease and one with local recurrence.Immediate TRAM flap reconstruction is associated with few complications. It can be recommended as theprimary choice following APR to obliterate pelvic dead space, perform vaginal reconstruction and close perineum with nonirratiated tissue.