Objective To explore the method of the distal perforator-based gluteus maximus muscle V-Y flap to treat the sacral ulcer and to simplify the operative procedures.Methods From March 2002 to March 2005, 11 cases of sacral ulcer were repaired by distal perforatorbased gluteus maximus muscle flaps. The area of sacral ulcer ranged from 13 cm×11 cm to 18 cm×14 cm. Of 11 cases, 7 were female and 4 were male,whose age ranged from 21 to 69 years, and the disease course was 8 months to 3 years.A triangular flap was designed to create a V-Y advancement flap.The length of the base was made almost equal to the diameter of the defect.The apex of the tringle was located near the great trochanter. The medial part of the flap was elevated as a fasciocutaneous flap by dissecting the layer between the fascia and the muscle.The distal part ofthe flap was elevated by dissecting the layer between the gluteus maximus muscle and the fascia of the deeper muscle group.The flap was advanced to the defect. Results All the flaps survived. After a follow-up of 5 months to 3 years, the bilateral buttocks were symmetry and whose appearance was satisfactory. Except for 1 case dying of other disease, no recurrence of ulcer was observed.All the flaps survived. Conclusion The distal perforatorbased fasciocutaneous V-Y flap for treatment of sacral ulcers is a simple and reliable technique, which has several advantages over the conventional V-Y flap technique,such as excelent excursion,viable coverage with the fasciocutaneous component, high flap reliability, preservation of the contralateral buttock, and preservation of the gluteus maximus muscle function.