A 30-year-old obese (BMI 35.3) female was struck by a tow truck and dragged for 30 ft. Initial trauma evaluation revealed a left sided closed femur fracture, treated with intramedullary (IM) nailing, and a humerus fracture with open reduction internal fixation (ORIF). Additional radiologic findings included a small bowel mesenteric hematoma, managed non-operatively, a small left flank hematoma, and six-rib fractures. The burn service was consulted on hospital day 5 for management of her abdominal friction burns (TBSA 13%), of which 4% appeared to be full thickness on initial evaluation [Fig. 1]. The patient was taken to the operating room (OR) for an uncomplicated tangential excision and allografting of the abdominal friction burn. Upon return to the OR 5 days later for planned excision of allograft and placement of autograft, significant progression of burn depth and adipose necrosis was noted and the left flank was distended and edematous. Upon further excision of necrotic adipose tissue, the underlying fascial-cutaneous separation (MLL) was discovered, and approximately 1.5 L of serosanguinous fluid was evacuated from this cavity [Fig. 2]. To prevent re-accumulation of fluid into this dead space, a 19F round Blake drain was placed in the dependent portion of the MLL, the overlying cutaneous defect was grafted with a 2:1 meshed split-thickness skin autograft, a negative pressure dressing was used to bolster the graft, and an abdominal binder was worn at all times. During the first 24 and 48 post-operative hours, 700 and 1055 mL of serosanginous fluid were drained, respectively. The primary dressings were removed 5 days post-autografting with satisfactory results [Fig. 3]; after 5 weeks, autograft take was noted to be > 95% with further aesthetic improvements appreciated [Fig. 4].