Use of the vacuum assisted closure device (VAC) for securing split-thickness skin grafts (STSGs) is associated with improved wound outcomes compared with bolster dressings. Consecutive case series. Consecutive patients at a level I trauma center requiring STSG due to traumatic or thermal tissue loss during an 18-month period. Repeated skin grafting due to failure of the initial graft. Secondary outcome measures included dressing-associated complications, percentage of graft take, and length of hospital stay. Sixty-one patients underwent STSG placement. Indications for STSG were burn injury (n = 32), soft tissue loss (n = 27), and fasciotomy-site coverage (n = 2). Patients were treated with the VAC (n = 34) or the bolster dressing (n = 27). The VAC group required significantly fewer repeated STSGs (1 [3%] vs 5 [19%]; P =.04). Two additional graft failures occurred in the no-VAC group, but repeated STSGs were refused by these patients. No difference was seen between the groups in age, percentage of graft take, or hospital length of stay. The no-VAC group had significantly larger grafts (mean +/- SD, 984 +/- 996 vs 386 +/- 573 cm(2); P =.006). The patients requiring repeated STSGs (n = 6) did not have significantly larger grafts than those not requiring repeated STSGs (mean +/- SD, 617 +/- 717 vs 658 +/- 857 cm(2); P =.62). No dressing-associated complications occurred in the VAC group. The VAC provides a safe and effective method for securing STSGs and is associated with improved graft survival as measured by a reduction in number of repeated STSGs.