BACKGROUND: The aim of this study was to compare wound complications from V-Y flap vs primary closure in the setting of abdominoperineal resection. METHODS: This was a single institution retrospective review (1999-2014). The main outcome measures were any wound complication, hospital length of stay, and unplanned readmissions. RESULTS: Among 80 patients included, 21 (26%) received reconstruction with V-Y flap. Compared with those who received primary closure, patients who underwent V-Y flap reconstruction had lower rates of overall wound complications (14.3% vs 64%, P = .002), superficial surgical site infection (6% vs 32%, P = .05), and wound dehiscence (4.5% vs 14%, P = .251 statistical significance not met). CONCLUSIONS: Reconstruction of perineal defect following abdominoperineal resection using a V-Y fasciocutaneous flap is a safe and efficacious alternative to traditional simple primary closure and is associated with reduced postoperative morbidity. Further comparative effectiveness studies should be undertaken to evaluate long-term and quality-of-life outcomes.