26 years old, male, paraplegic, with extensive sacral, ischial and trochanteric pressure sores. Fig. 1: initial aspect before treatment. Fig. 2: initial aspect before treatment. Fig. 3: different stages of LIGASANO® white treatment in order to clean the wound an to prepare it for surgery. Fig. 4: different stages of LIGASANO® white treatment in order to clean the wound an to prepare it for surgery. Fig. 5: different stages of LIGASANO® white treatment in order to clean the wound an to prepare it for surgery. Fig. 6: surgical procedure (Arnold and McGraw bilateral gluteus maximus musculocutaneous flaps). Fig. 7: surgical procedure (Arnold and McGraw bilateral gluteus maximus musculocutaneous flaps). Fig. 8: three days after surgery. Fig. 9: one week after surgery. Fig. 10: 10 days after surgery. Fig. 11: one month after surgery. Fig. 12: bilateral ischial pressure sores one year after the initial treatment. Fig. 13: bilateral ischial pressure sores one year after the initial treatment. Fig. 14: local treatment with LIGASANO® white. Fig. 15: after two weeks the wounds are clean and prepared for surgery. Fig.16: first step: direct closure and drainage. Fig. 17: second step: two very large bilateral posterior thigh flaps (“Tulenko flaps”) have been raised to cover the ischial pressure sores. Fig. 18: few days after surgery.