Abstract: Objective To evaluate the clinical efficacy of vacuum sealing drainage (VSD) technique in perforator flap grafting to treat severely crushed extremity. Methods From November 2008 to June 2010,VSD technique was used to manage the wounds of 30 consecutive patients with severe injuries at the extremity.They were 23 men and 7 women,aged from 18 to 65 years (average,32.3 years) . Free or pedicled perforator flaps were used to cover the wounds after an average of 9.4 days following VSD.Free anterolateral thigh perforator flaps were used in 13 patients; free anterolateral thigh perforator flaps were used in 5 in combination with an superficial circumflex iliac artery,in one case in combination with a superficial circumflex iliac artery flap and in one case in combination with the second toe; perforator flaps with superficial circumflex iliac artery were used in 3 cases; lateral retro-malleolar perforator flaps pedicled by peroneal artery were used in 6 cases; a pedicled peri-umbilicus perforator flap was used in one case. Results All flaps healed at one stage except one that had marginal necrosis at the proximal part of the anterolateral thigh flap and one delayed infection that responded to dressing.All the donor sites were directly sutured except 5 donor sites for anterolateral thigh flaps where skin grafting was needed.The mean follow-up of 1.2 years (from 6 months to 2 years) showed that all the flaps were tender and well shaped,without hypertrophic scars or genuine keloids at the donor site.Secondary tendon reconstruction was performed in 4 patients.Flap defatting was performed in 2 anterolateral thigh flaps.Finger separation and bone transplantation was performed each in one patient respectively.Either grasp and pinch or weight bearing was nearly recovered. Conclusion VSD technique in combination with primary debridement followed by delayed grafting of perforator flaps is safe and effective in the treatment of severely crushed extremity.