Objective To investigate the effects of two different skin grafts on wound repair of acute necrotizing fasciitis in neck region. Methods Clinical data of 18 patients with acute necrotizing fasciitis in neck region admitted to our department from Jan 2017 to Jan 2019 were analyzed retrospectively. All the patients were initially and successfully treated with vacuum sealing drainage (VSD) combined with surgical debridement technology. After recovery of the granulation tissue, skin grafting was performed for repair of wound surface to all the patients. All the 18 patients were randomly divided into two groups, i.e. experimental group and control group according to the skin graft adopted. Autologous thin skin graft was adopted in the patients of the treatment group (n=10), while specific artificial acellular dermal graft in the control group (n=8). The wound healing rate, visual analogue score (VAS), complication rate, graft survival rate and other indicators of both groups at 5, 15 and 30 d after surgery, as well as the time of complete remucosalization of the wound, total length of hospitalization, times of dressing change and mean time between changes were recorded and compared. Results ①The difference of wound healing rate between both groups at 5 d after surgery was statistically insignificant (P>0.05), while the wound healing rates of the experimental group at 15 d, 30 d were higher than those of the control group with statistically significant differences (P<0.05). ②The difference of VAS between both groups at 5 d after surgery was statistically insignificant (P>0.05), while the VAS scores of the experimental group at 15 d, 30 d were higher than those of the control group with statistically significant differences (P<0.05). ③The flap survival rate of the experimental group was 100% and that of the control group was 75%. ④The complication rate of the experimental group was 30.0%, while that of the control group was 87.5%. ⑤The total length of hospital stay of the experimental group was shorter than that of the control group, and the times of dressing change of the experimental group were less than those of the control. Conclusions With advantages of improving flap survival rate, shortening length of hospital stay and good therapeutic effect, autologous thin skin graft is worth promoting for wound repair of acute necrotizing fasciitis in neck region. The indications of artificial acellular dermal grafting should be strictly held due to low graft survival rate and high cost.