Temporoparietal fascia flaps are reported to have a 94% success rate in auricular reconstruction. Bilayer matrix (Integra™, Integra LifeSciences, Plainsboro, NJ) dermal graft alone has an average success rate of 76.6%. When combined with fibrin glue and negative pressure therapy (V.A.C.® Freedom®, KCI, San Antonio, Tex) the flaps have a success rate of up to 98% in patients with a variety of wound types and sites. Two patients are presented with failed temporoparietal fascia flaps. In addition, one also had prior failure of a split-thickness skin graft; the second also had failure of prior Integra split-thickness skin graft, and hyperbaric oxygen therapy. All 3 treatment modalities of bilayer dermal graft, negative pressure therapy, and hyperbaric oxygen used simultaneously allowed both flaps to heal.