Ulcerative lesions of the ischemic leg that cannot be revascularized present serious problems. Under carefully defined conditions, a muscle transposition procedure, with or without skin grafting, may be successful. The indications and contraindications, risks, and technical considerations have been presented. Nine patients formed the basis of this study: there was complete healing in six, partial healing in two, and complete treatment failure in one. It has been concluded that this operative approach should be considered in patients with an ulcerated ischemic leg, especially when amputation is being considered.