We describe a modified technique using the gluteus maximum muscle as a splitting myocutaneous flap to close specifically low sacral and coccygeal pressure ulcers. Twenty-eight patients with sacral or coccygeal stage IV pressure ulcers (average size 4 x 4 cm) underwent a gluteus maximus muscle-splitting myocutaneous flap when conservative treatment failed to heal the ulcer. Twenty-seven of the 28 patients had complete healing of the pressure ulcer site at an average follow-up of 15 months (range 2 to 40 months). Complications occurred in 7 patients, requiring revision of the flap in 2 patients. The advantages of this technique include reduced blood loss, preservation of most of the gluteus maximus for future use, and retained function of the gluteus maximus for stair climbing and single-limb support in the ambulatory patient. We recommend the gluteus maximus muscle-splitting myocutaneous flap as the procedure of choice for closure of small low sacral or coccygeal ulcers in both the ambulatory and nonambulatory patient.