Trunk and perineal defects after tumor resection present a challenge to the reconstructive surgeon. When primary closure is not possible, the use of well-vascularized autogenous tissue is required to achieve adequate soft-tissue coverage. Pedicled muscle or myocutaneous flaps provide excellent sources of vascularized tissue for postradiation defects. When local tissues preclude the use of pedicled flaps, free-tissue transfers can be performed. A thorough understanding of radiation wounds and the reconstructive options is essential for treatment of these challenging defects.