Pressure sores, and especially ischial pressure sores, are a serious concern in the life of paraplegic patients. The treatment of this pathology is obviously surgery, and several local flaps can be used for coverage. However, recurrent pressure sores in an active patient can be frustrating if all local flaps have been used. Free flaps are therefore the next option. In our experience, the free medial gastrocnemius musculocutaneous flap is the best option. This paper reports the closure of ischial pressure sores with a free medial gastrocnemius flap, the patient selection criteria used, and the postoperative care provided.