The cutaneous RAM flap was used successfully to repair a radiation-induced vesicovaginal fistula. Patient selection is important, ideally one with a fatty lower abdominal wall and without a previous incision transecting the inferior rectus muscle below the umbilicus. The RAM flap has excellent vascularity, allows augmentation of the bladder, and permits an extraperitoneal approach, factors that are important when operating in an irradiated field.