The complexity of the female pelvis and perineum becomes evident when traumatic or surgical defects need to be reconstructed; consideration should be given to the restoration or preservation of the most important functions subserved by this anatomic region. We used a composite pedicled fasciocutaneous anterolateral thigh flap with an innervated vastus lateralis muscle to reconstruct the pelvic ring, vagina, clitoris, labia and mons pubis. Unaided ambulation, urinary and anal continence were successfully restored. An appropriately designed pedicled ALT flap can be successfully used to achieve excellent pelvic/perineal reconstruction and functional restoration in complex pelvic/ perineal defects, even in children.Key Words: Trauma, Perineum, Pedicled ALT, Reconstruction