Background: The use of rectus abdominis myocutaneous (VRAM) flap in reconstruction is well documented; it is a reliable, versatile flap to fill defects in the walls of chest, abdomen, perineum and groin. We present a unique case of a single patient who underwent abdominoperineal resection and vaginectomy and reconstruction using a muscle sparing VRAM. Objectives & Methods: The VRAM flap is supplied by two major pedicles, the deep inferior and superior epigastric artery with additional supply from the subcostal and intercostal arteries. This case, a 45-year-old female with recurrent anal SCC underwent reconstruction of vaginal and peroneal defects with a modified VRAM flap. The medial third of the rectus muscle was identified and taken with the medial row and medial branches from the deep inferior epigastric artery. The lateral two thirds of the rectus muscle and lateral branches were preserved and maintained blood supply from the deep superior epigastric artery. Innervation from the intercostals, laterally, were preserved. The pedicle was dissected and inset into the defect. Findings & Conclusion: This approach prevents the consequences of VRAM flaps such as abdominal wall weakening and increased risk of hernia formation by maintaining vascularised and neurotised muscle tissue by preserving the lateral two thirds of the rectus muscle.