Recidivism after flap coverage of ischial and trochanteric pressure sores is predictably common. Available local flap options are limited in number and must be cautiously preserved as long as possible for these patients who are destined to have a lifelong vulnerability for recurrence. Muscle perforator flaps have been introduced as another set of alternatives to solve this conundrum. Since the posteromedial thigh often has been previously unviolated by the usual workhorse flaps selected for this problem, the adductor perforator flap will then usually still be available as an important “backup” option. If designed as a propeller flap, this version after rotation will cover the defect and simultaneously allow direct donor-site closure to avoid the need for a skin graft.