One of the great frustrations in burn care is the phenomenon of burn wound progression. In the first few days following injury, the inflammatory cascade and progressive tissue edema can contribute to further metabolic compromise of tissue and ultimate evolution of burn wounds. Such evolution produces a significant challenge in the clinical management of acute burns. The development of negative pressure wound therapy in the 1990s offered surgeons a weapon against damaging tissue edema and progressive injury. Its technology has proved successful on the microscopic level and has produced instrumental change in the field of burn care.