Abstract: Objective To discuss the clinical efficacy of in situ skin grafting in a zigzag pattern combined with vacuum sealing drainage (VSD) in the treatment of retrograde skin avulsion injury of limbs. Methods Total 15 patients with retrograde skin avulsion injury of limbs,9 males,6 females,average age 32.5 years (19 to 52 years),underwent in situ skin grafting in a zigzag pattern combined with VSD in our hospital between February,2014 and March,2015.There was no peripheral vascular disease among these patients,all skin avulsion was retrograde skin avulsion and complete,area of the avulsion skin was from (4 cm×5 cm) to (15 cm×18 cm),without or only with mild contusion,the subcutaneous soft tissue bed was good,or could be restored though accompanied by muscle rupture,without large area exposed bone and tendon.The antibiotics,anticoagulation and antispasmodic therapy were applied after the operation.The negative pressure was adjusted to keep unobstructed VSD dressing continuous drainage.The color,tube type and smell of VSD were observed after the operation.The VSD dressing was removed one week after the operation to assess the survival situation of the skin by recording the color,texture,elasticity and sensation of the flap. Results All 15 flaps survived uneventfully.Two cases were lost in the follow up of 3 months to 20 months.Three cases with distal partial blackened flap were healed by dressing.Compared with normal skin,there was no difference in the color,texture,elasticity and sensation of the proximal and central part of survival flap.However,the distal part of survival flap was dark,thin,poor elasticity,dysaesthesia or anesthesia. Conclusion The in situ skin grafting in a zigzag pattern combined with VSD show the advantages of simple and easy technique,short learning curve and satisfactory clinical efficacy,it is one of effective procedures in management of retrograde skin avulsion of limbs.