Wound healing complications are an unfortunate consequence of illness and injury. The prevention and management of wounds has evolved considerably over the past several decades secondary to a greater understanding of the wounding and healing processes. Abdominal wounds present clinicians with a unique challenge given the complexity of the anatomy, the patient, and the mechanical stresses applied to this region of the human body. Furthermore, patients presenting with abdominal wounds frequently suffer from physiologic derangements and co-morbidities that impede healing. Successful closure of the difficult abdominal wound requires a multifaceted approach. This approach includes optimization of the patient, appropriate local wound care, expeditious surgical interventions, and judicious use of technologies such as negative pressure wound therapies. While these components may have once been considered adjuncts to wound healing, advances in wound care have shown the necessity of addressing each aspect in order to improve patient outcomes.