Coverage of large, full-thickness flank defects can present a reconstructive challenge. We present a case of a 26 year old lady who underwent excision of a high grade leiomyosarcoma followed by radiotherapy to her right flank. The resulting defect was a 16 x 6cm transversely orientated full-thickness wound superior to the posterior iliac crest, with bone exposure. Multiple attempts at split skin graft reconstruction failed, and the available regional pedicled flaps options were not favourable due to previous irradiation. She subsequently underwent reconstruction with a free anterolateral thigh free flap, in which the descending branch of the lateral femoral circumflex vessels were anastomosed to the right deep inferior epigastric vessels (DIEV) which had been turned out laterally, thereby negating the need for vein grafts. The flap survived and went on to heal uneventfully with no complications. The transversely-orientated DIEV are a useful and reliable option as recipient vessels for free-flap reconstruction for flank defects, as this avoids the need for vein grafts, thereby reducing the number of anastomoses required and the creation of another donor site wound.