Clinical Problem: A 74 year old male presented with severe perineal pain and abscess. He had no significant PMH. Once diagnosis of Fournier’s gangrene was established, he was taken for surgical debridement of scrotum and perineum. An open wound of 15x10x4.8cm with bilateral superior and inferior tracts up to 5 cm resulted. Description of Past Management: Postop the wound was left open to monitor progression of necrotizing faciitis, repeat surgical intervention was anticipated, and a diverting colostomy considered. Dressing changes were started twice daily with 0.25% Dakins solution and pulsatile lavage used to decrease bioburden. HBO evaluation was requested, and nutritional support initiated. Onset of an acute MI limited treatment options, and fecal contamination was controlled with insertion of a bowel management system. Current clinical approach: Negative pressure wound therapy (NPWT), with use of an Ob-Gyn bed for dressing changes started 10days postop. White and black foam application was tailored to accommodate pain sensitive testicles. Negative pressure was maintained continuously at 75mmHg per patient tolerance, with dressing changes three times per week, initially done under conscious sedation. Nine days later granulation tissue covered testicles, encasing them after three weeks. NPWT supported adherence of testicles to wound base for stabilization, resulting in decreased pain for patient. Patient outcomes: NPWT was removed after week five per pt request to facilitate increased mobility. He now ambulated and ate well using oral supplementation of Oxyandrolone. He transitioned to an LTAC then home health setting for continued wound care with antimicrobial cleanser and hydro gel. His wound re-epthelialized except for an area of 2.5x1.5cm which was closed with a bioengineered graft. Conclusion: This case study demonstrates how NPWT facilitated granulation tissue formation and protected the woundbed of a hard-to-dress area in this patient. Product Notation: NPWT and V.A.C.® KCI Licensing Inc. 8023 Vantage Drive, San Antonio, Tx, USA