Pressure sores are a common complication of long-term institutional care. Surgical coverage of late-stage ulcers in the elderly refractory to conservative therapy remains controversial. The authors reviewed the outcome of 22 predominately nonambulatory, nonparaplegic, elderly patients with coverage of 27 pressure sores. The mean patient age was 59 years (range, 50–82 years). The average follow-up was 6 months (range, 3 months–2 years). There were 11 complications for the 22 patients (50%) and the 27 ulcers (41%). Postoperatively, a well-healed ulcer was present in 19 of 27 patients (70%) at 6 months. Of the 19 reconstructed sacral ulcers, there were 10 complications (53%) and one recurrence at 6 months. Seven trochanteric ulcers were covered with tensor fascia lata flaps without complications or recurrences at the 6-month follow-up. One ischial ulcer was managed using a V-Y hamstring advancement flap, resulting in dehiscence and a subsequent revision. The authors advocate surgical coverage to treat late-stage pressure sores in nonparalyzed elderly persons to reduce the morbidity, mortality, and economic burden of patients with late-stage pressure ulcers. With an increasing geriatric population, prevention and postoperative care are necessary to diminish the incidence, recurrence, and burden of pressure sores.