Introduction: Complex groin wounds occur commonly in many surgical subspecialty patient populations including those undergoing infrainguinal bypass, femoral cannulation for cardiac and transplant surgery, and urologic and gynecologic lymphadenectomy. No substantial single-muscle flap series has provided a consensus regarding wound management. This abstract reviews our experience with the rectus femoris muscle flap for complex groin wound reconstruction. Methods: Over the last five years, the rectus femoris has become our routine method of groin wound reconstruction. The rectus femoris is harvested through a mid-anterior thigh incision. The muscle is elevated on its pedicle and transposed into the groin wound defect through a subcutaneous tunnel. Hospital and outpatient records were reviewed for all patients undergoing groin wound reconstruction with this technique from 1999-2003. Results: Thirty-seven rectus femoris muscle flaps were performed in thirty-three patients. The mean age was 65.3 years (range: 25 to 88). Thirty (81.1%) groin wounds occurred following infrainguinal revascularization, twenty-three (76.7%) of which contained prosthetic material. Five (21.7%) of these wounds had their prosthetic material removed at the time of reconstruction. The remaining seven groin wounds (18.9%) occurred following femoral vessel cannulation for either cardiac or transplant surgery. There were no intraoperative mortalities, and no anastomotic hemorrhages. There were no flap losses. 35 of the 37 treated wounds healed (94.6%), 26 primarily (70.3%), and 9 (24.3%) following delayed healing and contracture. Reoperation was performed in one (2.7%) patient for flap readvancement and in three (8.1%) patients for prosthetic graft removal following initial flap reconstruction. Two patients (6.1%) died during their hospitalization with persistent open groin wounds following flap reconstruction. All muscle flap donor incisions healed with only two (5.4%) experiencing minimal delayed healing. There were no donor site wound infections and no donor sites required reoperation. Thirty-three (89.2%) groin wounds demonstrated culture-positive microbial infection, fifteen (45.5%) of which were polymicrobial. The thirty day mortality rate was 15.2% and the 6-month mortality rate rose to 27.2%, with multi-system organ failure as the most common cause. Conclusions: The rectus femoris muscle flap is an effective and reliable means for complex groin wound reconstruction. The muscle flap is dependable and the donor site not problematic even in the presence of peripheral vascular disease. Based upon our clinical results, we believe that the rectus femoris muscle flap is the “flap of choice” for groin wound reconstruction.