From August, 1996 to June, 2000, 33 patients received transfer of free thoraco-umbilical flaps for repair of various soft-tissue defects. The size of the flaps ranged from 10 to 40 cm in length and 8 to 25 cm in width, with blood supply of the flaps derived from the largest periumbilical perforating branch of the deep inferior epigastric vessels. The indications of this flap included complex extremity trauma or large skin loss resulted from soft tissue tumor resection, either acute or postprimary. The overall success rate was 100% in the 33 cases. The donor area was closed directly with 10- to 12-cm-wide flaps, leaving an inconspicuous scar, whereas larger flaps required skin grafting. A 2-year follow-up found uneventful healing of all the flaps with minimal donor abdominal morbidity.