Problem : A 55 year old female with a BMI of 36 presented to the Emergency Department with the complaint of abdominal pain, vomiting,and diarrhea for 24 hours. Previous surgeries included a colon resection at age 13 with a temporary colostomy due to a gunshot wound. A three/pack a day smoker, she stopped smoking 20 years ago. Listed in her history are CHF, hypertension, hepatitis C, rheumatoid arthritis, and chronic vascular insufficiency to her extremities. Past Management: Since the abdominal pain increased, an exploratory laporotomy was performed. An infarcted colon and necrotic gall bladder were resected. An incisional hernia was repaired and a diverting ileostomy was formed. The wound was left open with a saline dressing. Management: Fearing dehiscence, negative wound therapy was applied the next day. However,ten days later the therapy was interrupted to allow a MRI. During the procedure, she coughed; fascial dehiscence and small bowel were seen in the wound. In surgery necrotic fascia was debrided and two large porcine grafts were placed to fill the defect. NPWT was applied with the promise of stronger antitussive medication. Outcome: Three weeks later, she was discharged with portable NPWT. Unfortunately, she had numerous admissions for nonwound related issues over the next four months. Awaitng medical stability, NPWT provided constant wound care. For this patient, this therapy prepared a granulating base for a successful STSG. She is pleased with the outcome, slowly losing weight by diet, and staying out of the hospital - "knock on wood". A pictorial display will outline wound sizing, fascial dehiscence with small bowel, and closure with STSG.