Introduction: The rectus abdominus free flap is a large muscle or musculocutaneous flap that was first described by Pennington in 1980. It provides the largest potential skin paddle of any flap and is very versatile making it useful for the reconstruction of a variety of large and complex defects. Few studies have described experience in follow up and outcomes of this flap despite its wide use. This study aimed to review our experience with the use of this flap at the Royal Adelaide Hospital. Method: A retrospective review of 39 patients who had rectus abdominus free flaps between 2004-2019 was conducted. All available paper and electronic documentation pertaining to pre-operative work up, perioperative, operative and post operative progress were reviewed. The main outcomes audited were: flap failure, haematoma, seroma, infection, dehiscence, aesthetic and functional concerns. Results: There were 39 patients (25 M, 15F, mean age 54.6) with 30 requiring oncologic reconstruction and 9 requiring trauma reconstruction. Only 1 flap had total failure and 1 with partial failure. There were 3 incidences of hematoma, 2 seromas, 2 infections and 9 incidences of minor wound dehiscence. There were no hernias and only one case of minor abdominal wall weakness. Four patients had aesthetic concerns which required minor corrections. Mean follow up was 27 Months. Conclusion: Rectus abdominus free flaps are versatile and reliable flaps in the reconstruction of traumatic and oncologic defects, with few major complications.