Introduction: Administration of sub-atmospheric pressure therapy (SAT) improves wound healing ability, increases granulation tissue matrix, and skin graft survival. Purpose: Does SAT accelerate bi-laminate membrane incorporation, and reduce complications. Materials and Methods: Twenty patients (6 to 72 years) presented with wounds too extensive for immediate coverage. Group A (10pts.) had IntegraŽ placed while Group B (10pts.) had the IntegraŽ secured with SAT (Wound VAC). Results: SAT over IntegraŽ accelerated the incorporation of the matrix into the scaffold from 10-16 days in group A, compared to 4-7 days (group B) (p<0.001). Matrix incorporation was 80% over tendon in group A, and 98% in group B. Skin graft survival was 80-90% in group A and 99-100% in group B. Group A had 33% infection rate (3/10) and 0% in group B. At 10-16 days the wounds were completely closed in group B; however 3 patients in group A (33%) with exposed tendons required free flap coverage with increased hospital stay. Conclusion: We recommend utilization of IntegraŽ and SAT in extensive wounds that do not appear amendable to immediate primary closure, thereby, providing an alternative for patients who are not candidates for free flaps.