A 63-year-old paraparetic man presented with a large ischial pressure sore over the left buttock region. A failed surgical attempt using gluteal thigh flap transfer rendered the reconstructive task a challenging issue. In the absence of suitable regional flaps or any accessible recipient vessels nearby, we must employ a novel strategy to solve the clinical problem. The entire length of the deep femoral vessel was isolated through the anterior approach, which was then transposed posterior wards to the gluteal region to nourish a latissimus dorsi myocutaneous free flap while the patient was laid prone. The wound healed uneventfully and the patient remains ulcer-free throughout 3 years of follow-up.
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