Soft tissue loss from infectious, vascular, and traumatic disorders often results in poor healing, painful wound care, and the need for repeated operations. This retrospective study evaluates a single-institutional experience with negative pressure therapy (NPT), using the vacuum-assisted closure (VAC) device in a group of children with diverse soft tissue problems. The medical records of 51 patients treated with NPT from January 2000 to July 2003 were reviewed for demographics, diagnosis, duration of VAC therapy, wound closure, recurrent disease, and complications. Patients were classified by diagnosis: group 1: pilonidal disease (n = 21, primary = 6 and recurrent = 15); group 2: sacral and extremity ulcers (n = 9); group 3: traumatic soft tissue wounds (n = 9); and group 4: extensive tissue loss (n = 12) from the abdominal wall (n = 7), perineum (n = 2), thigh (n = 2), and axilla (n = 1). Group 1 had an average age of 16 years (range, 10-20 years), 67%were obese, and had an average length of follow-up of 13 months (range, 8-36 months). VAC was placed in the operating room in 95%with subsequent outpatient care that included dressing change 3 times weekly. Healing occurred in all patients with primary disease at an average of 37 days. For patients with recurrent disease, 12 healed at an average of 48 days and 3 developed recurrent sinuses. Group 2 was treated with VAC as a bridge to skin grafting or flap closure. All children in group 3 achieved healing without skin grafting at an average of 10 days and with acceptable cosmesis. Negative pressure therapy in group 4 was the only wound treatment in 10 patients and adjunctive to operative closure in 2. Complications from VAC occurred in 5 patients: retained sponge in 2 and device malfunction in 3. Negative pressure therapy offers a safe, cost-effective alternative to traditional complex wound care in children. Its advantages are less frequent dressing changes, outpatient management, resumption of daily activities including return to school, and a high degree of patient tolerance. This retrospective study evaluates a single-institutional experience with negative pressure therapy (NPT), using the vacuum-assisted closure (VAC) device in a group of children with diverse soft tissue problems. The medical records of 51 patients treated with NPT from January 2000 to July 2003 were reviewed for demographics, diagnosis, duration of VAC therapy, wound closure, recurrent disease, and complications. Patients were classified by diagnosis: group 1: pilonidal disease (n = 21, primary = 6 and recurrent = 15); group 2: sacral and extremity ulcers 9); and group 4: extensive tissue loss (n = 12) from the abdominal wall (n = 7), perineum (n = 2), thigh (n = 2), and axilla an average age of 16 years (range, 10-20 years), 67% were obese, and had an average l ength of follow-up of 13 months (range, 8-36 months). VAC was placed in the operating room in 95% with subsequent outpatient care that included dressing change 3 times weekly. Healing occurred in all patients with primary disease at an average of 37 days. For patients with recurrent disease, 12 healed at an average of 48 days and 3 developed recurrent sinuses. Group 2 was treated with VAC as a bridge to skin grafting or flap closure. All children in group 3 achieved healing without skin grafting at an average of 10 days and with acceptable cosmesis. Negative pressure therapy in group 4 was the only wound treatment in 10 patients and adjunctive to operative closure in 2. Complications from VAC occurred in 5 patients: retained sponge in 2 and device malfunction in 3 Negative pressure therapy offers a safe, cost-effective alternative to traditional complex wound care in children. Its advantages are less frequent dressing changes, outpatient management, resumption of daily activities including return to school, and a high degree of patient tolerance.