Objective To compare the clinical effects of skin grafting combined with vacuum sealing drainage and pressure dressing in burn plastic surgery. Methods A total of 78 burn patients who underwent plastic surgery in our hospital from April 2023 to April 2024 were randomly divided into reference group and experimental group, with 39 patients in each group. The reference group was treated with skin grafting combined with pressure dressing, and the experimental group was treated with skin grafting combined with vacuum sealing drainage. The degree of tissue softness, scar hyperplasia, treatment cost, hospitalization time, skin grafting healing time, total effective rate of clinical treatment and complication rate were compared between the two groups. Results The total effective rate of treatment in the experimental group was higher than that in the reference group, and the incidence of complications was lower than that in the reference group (P <0.05). The scores of tissue softness and scar hyperplasia in the experimental group were higher than those in the reference group (P <0.05). The treatment cost of the experimental group was lower than that of the reference group, and the hospitalization time and skin graft healing time were shorter than those of the reference group (P <0.05). Conclusion Both skin grafting combined with vacuum sealing drainage and pressure dressing have certain effects in clinical burn plastic surgery, but skin grafting combined with vacuum sealing drainage has better therapeutic effect, which can promote tissue healing, shorten hospitalization time and skin grafting healing time, reduce scar hyperplasia and reduce the incidence of complications.