Aims: Introduction of the new VAC dressing has greatly facilitated the management of open abdominal wounds. This study looks at the use of VAC dressings in patients who have undergone multiple major abdominal surgeries. Methods: Nine patients admitted to an Intensive unit of a District General Hospital , between the year 2004 /5, had a VAC dressing applied after surgery for following indications: multiple stab wounds (n=1), abdominal compartment syndrome (n=2), necrotising pancreatitis (n=3), abdominal dehiscence (n=2) and anastomotic leak after low anterior resection (n=1). Three patients had an enterocutaneous fistula. Initial management involved covering the exposed bowel with a Bogota bag. VAC dressing with open pore foam dressing interface was used to avoid injuring the bowel and a continuous negative pressure of 125 mm of Hg was applied (Topical Negative Pressure TNP). The suction applied helped exert a centripetal force on the wound edges drawing them closer (Reverse Tissue Expansion). It reduced the bacterial load in the wound by continuous suction of the effluent fluid, which could be accurately measured and sent for microbiological or biochemical assessment if required and made the wound easy to manage. Dressings were changed under strict aseptic precautions whenever the suction effect was lost. VAC therapy was discontinued after the wound granulation tissue reached the skin edges. Wound healing was monitored with serial photographs Results: The average duration of VAC dressing application was 27 days (range14 to 52 days). Two patients died due to sepsis, however both the wounds were healthy. In the remaining cases wound improvement and closure was achieved effectively without need for further complex procedures. The 2 patients with enterocutaneous fistulae arising from the jejunum and ileum were controlled well as low output fistulae. The patient with fistula due to anastomotic leak after anterior resection closed spontaneously. One patient needed a skin grafting and 1 patient developed an incisional hernia. VAC dressing facilitated nursing of patients and in addition removed much of the odour associated with conventional methods of open dressing. Conclusion: VAC dressing has revolutionised the management of difficult abdominal wound closure and control of sepsis, avoiding the need for relook laparotomies and repetitive change of open dressing. The presence of an enterocutaneous fistula was not a contraindication for its use.