Large midline abdominal hernias are reconstructed with bilateral rectus turnover flaps in a series of 15 patients. Each rectus muscle is turned over from a retracted lateral position to the midline, providing a complete abdominal closure with fascia and muscle. The repairs were frequently reinforced with synthetic materials, but synthetic material was not placed over bowel and simply sutured to the edge of a large hernial defect. The rectus turnover method of reconstruction appears to have significant advantages over the use of synthetic material alone. Successful hernia repair was accomplished in all patients. The surgical technique and complications encountered are described in detail.DeFranzo AJ, Kingman GJ, Sterchi JM, Marks MW, Thorne M. Rectus turnover flaps for the reconstruction of large midline abdominal wall defects.