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Skin graft and flaps have become common practice in the plastic surgery specialty and have been demonstrated as safe and effective surgical procedures. The most common indications for a skin graft or flap is a third degree burn, chronic ulcer and trauma. Skin graft failure may occur for a variety of reasons, with incidence reported between 2 and 30%. There are currently no studies on the effect of osteopathic manipulative treatment (OMT) on skin graft failure. A retrospective chart review of electronic medical records for thirty-three patients who underwent a skin graft or skin flap procedure from January 1, 2010 to December 31, 2015 at a community based hospital in the Bronx, NY was conducted. Variables which increase the likelihood of graft and flap failure such as immunodeficiency, polytrauma, substance abuse as well as flap and graft complications were collected and treatment patients were matched to controls for such variables. Twelve patients received osteopathic manipulative treatments and twenty-one patients did not. None of the skin grafts or flaps failed in the patients who received OMT as compared to four graft or flap failures in those who did not receive OMT. We feel the lack of statistical significance is due to the low study population. The data, however, is promising and suggests a potential role for OMT in flap and graft patients. This study indicates the need for further research into the effectiveness of OMT in the prevention of flap and graft failure. [ABSTRACT FROM AUTHOR]