Extensive low lumbosacral irradiated defects often require free tissue transfer to achieve closure. The well-known transpelvic path allows the inferiorly based vertical rectus abdominus myocutaneous flap (VRAM ) closure of pelvic and sacrectomy defects. In our 3 cases, the large defects were off the midline. Division of the sacral tuberous ligament enlarged the greater sciatic foramen to create a direct route for the ipsilateral, inferiorly based pedicled VRAM flap to close unilateral gluteal defect up to 300 cm2. This maneuver allows wound closure without free tissue transfer.