The use of skin grafts after lower extremity amputation in pediatric patients remains a controversial decision. A skin graft may help to preserve residual limb length and knee joint function; however, the literature suggests that it may make the patient more susceptible to complications. Directly contrasting children with and without skin grafts on their residual limbs will provide important data for the clinician making this decision. This study compares amputation characteristics, complications, and functional outcomes of these two populations. A retrospective chart analysis was performed on 45 pediatric patients who underwent lower extremity amputation between 1997 and 2006. Patients were divided into two groups: the graft group had skin grafts on their residual lower extremity limb(s) and the no graft group had no skin grafts present on the residual lower extremity limb(s). The mean time from amputation to follow-up was 4.5 years in the graft group and 7.0 years in the no graft group (P = .07). The average age at amputation for the graft group was 9.4 ± 1.4 years and 5.9 ± 1.1 years for the no graft group (P = .04). The graft group had a significantly longer hospital stay with 91 inpatient days vs 31 inpatient days in the no graft group (P = .03). There was no increased incidence of surgical revisions or reported problems with prosthetic wear in the graft group. Both groups achieved comparable levels of independence with ambulation. The presence of skin grafts on a child’s amputated limb does not adversely affect functional outcome and does not lead to greater prosthetic complications for the child.