The optimal subatmospheric pressure with the VAC system for wound healing appears to be approximately 125 mm Hg, using an alternating pressure cycle of 5 minutes of suction, followed by 2 minutes off suction. Dressing changes should be made every 48 to 72 hours to prevent growth of granulation tissue into the foam dressing. The VAC device can be applied over any type of tissue. Prior to application, the wound should be free of necrotic tissue and well vascularized. Complications with the VAC system are infrequent and usually yield low morbidity. These complications are typically associated with inadequate wound bed preparation, infrequent dressing changes, or inadequate pressures applied. Therapy with the VAC system has also been associated with local skin irritation, pain, maceration, tissue necrosis, bleeding, and infection. Owing to its mechanism of action, ie, through the application of subatmospheric pressure, the VAC system could be considered a minimally invasive interventional therapy and thus a potential eliciting factor for pathergy in PG ulcers. However, as shown in this report, the VAC system appears to exert its beneficial effect on long-term wound healing without the theoretical detrimental effects in a stable PG ulcer.