BACKGROUND Inguinal lymphadenectomy is performed for the treatment of nodal metastases from squamous cell carcinoma of the penis and other tumors of the trunk and lower extremity. Malignant skin infiltration requires wide resection, producing a defect requiring complex soft-tissue reconstruction. We have used a pedicled anterolateral thigh flap as our first-choice flap for these cases. We report a prospective series of cases using this recently described flap for reconstruction of groin defects after radical groin dissection. METHODS From May 2001, 6 patients with locally advanced inguinal disease underwent wide skin excision and en bloc nodal resection with immediate reconstruction using a pedicled anterolateral thigh flap. Data were collected prospectively, and the data of 4 of 6 patients were reviewed at 6 months postoperatively. No flap losses occurred. Complete healing was achieved in all patients. The mean hospital stay was 18 days. The median time to complete healing was 33.5 days. The complications were seroma leading to flap congestion, wound dehiscence, wound infection, and delayed healing. The donor sites were either closed primarily or split skin grafted. CONCLUSIONS Reconstruction using a pedicled anterolateral thigh flap in patients with advanced inguinal nodal disease is a useful adjunct in selected patients. We present our indications for the procedure, our rational for the choosing this technique over other methods of reconstruction, and the difficulties we experienced.