Aim: The reconstruction options for pressure ulcers have been widely reported, but there is still a need for ideal method in ischial pressure ulcer reconstruction. The aim of this study is to compare the development of recurrence and wound site complications and length of stay in two different patient groups who were treated for ischial pressure ulcers with a combination of gracilis muscle flap and fasciocutaneous flap procedures and those who were treated only with local fasciocutaneous flaps. Methods: Between 2016 and 2022, a total of 34 patients with Grade 3 and 4 ischial pressure ulcers were analyzed retrospectively in the Plastic, Reconstructive, and Aesthetic Surgery Clinic of Çukurova University’s Faculty of Medicine. Of this total patient group, 18 were treated with a combination of gracilis muscle flap and fasciocutaneous flap procedures (Group 1) and 16 were treated with local fasciocutaneous flaps (Group 2). Results: The mean age of the patients was 39 in Group 1 and 44.5 in Group 2. Group 1 patients had a mean length of stay of 9 days, while those in Group 2 had a mean length of stay of 15 days. Early postoperative complications such as dehiscence and hematoma occurred in both patient groups. While complications occurred in 6 patients in Group 1 (33.3%), 7 patients experienced complications in Group 2 (43.8%). Conclusions: Reconstruction of ischial pressure ulcers is very problematic due to high recurrence rates. Therefore, a wide range of repair options have been defined. Fasciocutaneous flaps may be insufficient to obliterate the dead space alone. In addition to a skin flap, gracilis muscle flap can be an effective option for the ischial cavity with better surgical outcomes.