Introduction: Pressure ulceration is a common problem for long-term bedridden patients and individuals with traumatic paraplegia.Necrotizing fasciitis can be a life-threatening complication caused by pressure ulcers, especially for debilitated elderly patients.In this report, we describe the successful use of negative pressure wound therapy with instillation to treat severe complex pressure ulcers complicated with peri-anal necrotizing fasciitis.Case presentation: A 58-year-old Chinese woman was admitted to our hospital with severe complex pressure ulcers on her bilateral ischial tuberosities, left hip, perineum, and left sacrococcygeal region.The wounds had been present for nearly 2 years.Her seventh and eighth thoracic vertebrae had been traumatically injured;she had been bedridden for 5 years.She was also diabetic.Her medical history and laboratory investigations confirmed severe complex pressure ulcers complicated with necrotizing fasciitis.Antibiotic therapy was initiated.Following negative pressure wound treatment with instillation, the topical infection subsided and final closure of the wound occurred after 130 days.Conclusions: Negative pressure wound treatment with instillation is an effective treatment protocol.It can reduce healing time, and promote long-term functional and cosmetic outcomes in debilitated patients with severe complex pressure ulcers complicated with necrotizing fasciitis.