Management of soft-tissue defects over the Achilles tendon presents specific challenges to the plastic surgeon. Primary closure or local flaps are often not feasible repair options for such wounds, and many of these patients may be poor candidates for free-tissue transfer secondary to their comorbidity. In this case series, the use of negative-pressure therapy in the preoperative period to prepare the wound bed for placement of a split-thickness skin graft and in the immediate postoperative period as a dressing for the graft was successfully used in 3 patients with soft-tissue defects over the Achilles tendon with exposed tendon. All 3 patients had stable wounds at 48 to 80 months postoperatively. Negative-pressure therapy and skin grafting was found to be a reliable method of repair that provided stable coverage for such wounds.