ObjectiveThe authors describe the technique of closure of a 7-cm vesicovaginal fistula involving the trigone and bladder neck with a suprapubic approach and a myocutaneous gracilis flap.Materials and MethodsA patient underwent the procedure in a primary attempt to close the fistula. She required two additional procedures for correction of small cribriform fistulas, which then resulted in complete closure of the original injury.ConclusionAn abdominal approach using a myocutaneous gracilis flap for the repair of a vesicovaginal fistula is a particularly useful technique for restoring a large area of tissue loss and maintaining bladder and vaginal capacity.