American Society of Plastic Surgeons. This is an open-access

The ischial region is the site most affected by pres-sure sores, with the highest recurrence and com-plication rates among common affected sites.1,2 Following recurrence, another donor site is needed for an additional reconstructive procedure. Work-horse flaps for ischial pressure sores have included inferior gluteus maximus island,3 gluteal thigh,4 V-Y hamstring musculocutaneous,5 and gracilis musculo-cutaneous flaps.6 Each flap has advantages and disad-vantages, such as the distance between the ischial bone and the vascular pedicle of the flap, flap volume, and flap tension when in the sitting position. Perforator flaps are a safe and dependable meth-od used in reconstructive plastic surgery.7,8 The con-Received for publication December 8, 2013; accepte