Abstract: Objective To investigate the effect of different thin-medium-thick skin grafts combined with vacuum sealing drainage (VSD) on the outcome of emergency trauma with large-area skin avulsion. 
Methods Seventy patients with emergency trauma with large-area skin avulsion were selected and divided into skin graft harvesting group (n=35) and reverse skin graft harvesting group (n=35) according to different methods of skin graft harvesting. The two groups were compared in terms of healing, number of dressing changes, length of hospital stay, treatment expenses, visual analogue scale (VAS) score at 12 h, 24 h, 48 h and 72 h after treatment, Vancouver Scar Scale (VSS) score, skin sensation at the affected area and complications. 
Results The rate of primary healing in the reverse skin graft harvesting group was higher than that of the skin graft harvesting group, the number of dressing changes was less than that of the skin graft harvesting group, and the length of hospital stay was shorter than that of the skin graft harvesting group (P＜0.05). The VAS score at 12-72 h after surgery showed a decreasing trend in both groups, and there were significant differences in interaction between groups, time points and time points between groups (P＜0.05). The color, thickness, and softness of the VSS score in the reverse skin graft harvesting group were lower than those in the skin graft harvesting group, and the skin sensory grading of the affected area was better than that in the skin graft harvesting group (P＜0.05). There was no significant difference in the treatment expenses and complication rate between the reverse skin graft harvesting group and the skin graft harvesting group (P＞0.05). 
Conclusion Compared with thin-medium-thick skin graft harvesting, reverse thin-medium-thick skin graft harvesting combined with VSD in the treatment of emergency trauma patients with large-area skin avulsion have a higher primary healing rate, lower pain, better aesthetic effects, better skin sensation, fewer dressing changes, and shorter hospital stay, and will not increase the risk of complications and treatment expenses. 

Key words: skin avulsion, drainage, treatment outcome