We aimed to present the results of our different clinical practise experience about the treatment and management of extremely difficult wounds using the vacuum-assisted closure system (VAC). In this retrospective study, we analysed the records of 51 consecutive patients who were applied VAC for different clinical practise between 2008 and 2012 at the Izmir Katip Celebi University, Ataturk Education and Training Hospital. There were 51 patients in our study with an average age of 54.6(16-78) years and 22(43.1%) were male, and 29(56.9%) were females. We used VAC system to manage the wound in 29(56.9%) patients with wound dehiscence (with or without fascial necrosis), in 17(33.3%) patients with open abdomen, and in 5(9.8%) patients with Fournier gangrene. The average hospital stay was38.4 days (10-101). The average duration of VAC application was 24.3 (8-56) days. The average number the application of VAC dressingswas 12.01 (3 to 28).Directly VAC related complications (enteroatmospheric fistula and wound haematoma) were seen in two patients (3.9%). A total of 27(52.9%) patients underwent delayed primary or graft closure. In the remaining 19(37.2%) patients, the wound was left to granulate and heal by secondary intention.5 (9.8%) patients died because of complications related to primary disease while on VAC application.We concluded that VAC is an important tool in the armamentarium of the surgeons managing in patients with complex and difficult wounds, particularly, in cases of open abdomen.