BACKGROUND Most abdominal wall defects can be repaired with a mesh, components separation technique or pedicle flaps, but a free flap reconstruction might be the only option for large epigastric or non-midline defects. This retrospective study reviewed the results of consecutive patients who had extensive full-thickness abdominal wall defects reconstructed with a large, microvascular tensor fasciae latae (TFL) flap. METHODS A 30-35 × 15-20-cm TFL flap was harvested and microvascular anastomoses were performed using a saphenous arteriovenous loop. RESULTS From 1995 to 2009, 20 patients were operated on with a TFL flap. The repair was combined with a mesh in nine patients, components separation in one patient, and both techniques were used in one patient. The median follow-up was 2 (range 0·5-13) years. There were no perioperative deaths, or intra-abdominal or deep surgical-site infections. The flap failed in one patient, two patients had minor distal tip necrosis of the flap and one developed a recurrent hernia 3 months after TFL repair. CONCLUSIONS A microvascular TFL flap is a feasible option for reconstruction of exceptionally large abdominal wall defects if other means of reconstruction have already been used or are insufficient. It can also be combined with other methods of reconstruction. A close collaboration between plastic and abdominal surgeons is important. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.