Although myocutaneous flaps have evolved into a primary method for managing pressure sores, their value in reducing the recurrence rate by padding the pressure point is open to question. The use of muscle to cover a pressure point violates the normal soft–tissue coverage of a bony prominence and introduces a tissue that is exquisitely sensitive to ischemia. Clinical follow–up of patients who have had myocutaneous flaps for closure of pressure sores demonstrates almost total muscle atrophy. Although skin coverage is stable, the muscle bulk of a myocutaneous flap is not retained beyond one to two years. The long–term value of myocutaneous flaps in reducing the recurrence rate of pressure sores requires careful follow–up in major series of cases.