Skin graft contraction is a common and intractable problem. The current treatments focus on mechanical opposition of contractile forces using splints and on compression of the grafted skin with pressure garments. For the patients, this causes significant morbidity with restriction of joint mobility and often requires multiple episodes of corrective surgery. Despite 50 years of research in this area, treatment and prevention of graft contraction have progressed very little and understanding of the underlying mechanism remains poor. This article reviews the clinical problem and the approaches used to prevent or treat graft contracture. It also considers to what extent we currently understand the cellular basis of graft contracture, based on in vitro models of skin contraction and in vivo observation of patients.