Abstract :Pressure ulcer formation is the result of unrelieved pressure, tissue shearing, and localized ischemia over a bony prominence resulting in cell death and tissue necrosis. The incidence of pressure ulcers in the spinal cord injury population is estimated between 25 – 66%. When meticulous wound care, control of infection, local debridement, and pressure offloading fail, patients require wound excision and vascularized soft tissue reconstruction. Recurrence rates of chronic ulcers are high, reported over 30%, ultimately resulting in multiple operations and eventual exhaustion of all other local tissue flaps. Lower extremity disarticulation and total thigh flap is the last resort treatment for the reconstructive surgeon. This report describes a paraplegic patient with T6 complete spinal cord injury with recurrent sacrococcygeal and bilateral ischioperineal pressure ulcers requiring right lower extremity disarticulation and total thigh flap.