Introduction: Extensive abdominal wall defects may result from tumor extirpation, traumatic injury, or soft tissue infections and often disrupt the soft-tissue content of the abdomen and the bony support that the pelvis provides to structures within the abdomen and pelvis. Reconstruction of the lower abdomen should aim to recreate dynamic stability. Methods: Four patients with extensive lower abdominal wall disruption were treated at our institution using a novel flap for functional reconstruction. We devised a free neurotized osteomyocutaneous tensor fascia latae (TFL) flap that would restore bony continuity by providing a vascularized bone flap and simultaneously maintain the integrity of the attachment of the TFL muscle to the iliac crest and reestablish musculofascial continuity. A branch of the superior gluteal nerve was coapted to an intercostal nerve to reinnervate the muscle, thus creating a relatively strong and dynamic muscle in these active patients. Results: All four patients underwent successful free tissue reconstruction with 100% flap survival. The lower abdominal wall and bony integrity of the pelvis were successfully reconstructed. Reinnervation is currently being followed clinically. Conclusion: The innervated TFL osteomyocutaneous flap is an ideal option for lower abdominal reconstruction in young patients with complex abdominoperineal reconstructions.