Introduction. Chronic wounds are physically debilitating and painful and are responsible for the addition of more than $25 billion annually in health care costs in the United States. Extracellular matrix (ECM) replacements have been demonstrated to aid in wound healing by providing an optimal environment to facilitate the healing process. Objective. This study examines the healing rates of stage 4 pressure ulcers using combination of a commercially available porcine-based wound matrix dressing alongside negative pressure wound therapy (NPWT) versus using NPWT alone. Materials and Methods. Patients were randomized to receive either the matrix plus NPWT (study) or NPWT alone (control) for stage 4 sacral pressure ulcer treatment. Wounds were photographed and measured weekly. The experimental group had their ECM dressings changed every other week and their NPWT changed twice weekly. Results. A total of 16 patients, 8 study and 8 control, completed this study. After the 12-week study period, the average control patient healing rate was 45.79% as compared with the 89.98% healing rate in the study group (P < .01). The difference in healing rate between control and study patients was optimal by 12 weeks. Conclusions. These studies suggest that ECM dressings may be a promising adjunctive treatment option for stage 4 pressure ulcers.