In modern science the changes of scientific paradigm occur constantly and often unnoticed. Effects of new therapy procedures that are not compatible with the prevailing doctrines first lead to contradictory discussions and may then lead to new doctrines depending upon the general perception. Continuous computer-assisted local negative pressure therapy (vacuum assisted closure therapy/V.A.C., topical negative pressure treatment) has led to unexpected and impressing clinical results since its introduction. This has provoked a recognizable change of different therapeutic concepts in reconstructive surgery. Based on a selection of important clinical examples from reconstructive surgery following a current literature research the attempt is undertaken to point out recognizable changes of paradigms within the treatment algorithms that can be discerned after the the introduction of vacuum therapy in recent years.