Vacuum therapy is an efficient alternative to conservative wound care and creates new possibilities for the treatment of a variety of chronic and acute wounds. Already more than two thousand years ago vacuum treatment was applied in traditional Chinese medicine and also today vacuum therapy is used more and more frequently in daily clinical practice. The positive effects of the therapy are based on the stimulation of blood flow, formation of granulation tissue, angiogenesis, as well as cell proliferation, accelerated secondary wound closure and the removal of bacteria from the wound. As can be demonstrated based on a clinical picture of the open abdomen, vacuum therapy based on KCI's (Kinetic Concepts Inc) VA.C. system (Vacuum Assisted Closure) provides a possibility for not only accelerating the healing process, but also significantly lowering mortality. Since vacuum therapy in the form of the V.A.C. system represents a relatively expensive intervention, a comparison with conventional healing methods is demonstrated. Clinical studies with high evidence level show that both economic and clinical advantages of the vacuum therapy speak for its application. Savings with respect to the faster healing rates, the reduced dressing changes, as well as hospital stay and the care requirements, and the reduction of subsequent illnesses, compensate for the higher initial costs. Although many reports exist on treatment successes with the application of V.A.C. therapy, there are several cases for which vacuum therapy is contraindicated. In order to make sure that V.A.C. therapy is effective, a range of precautions and contraindications are described. The European Wound management Association (EWMA) just wrote a position paper on V.A.C. therapy. This is available at www.ewma.org.