Plastic surgeons have been pivotal in the development of negative pressure wound therapy (NPWT), which has revolutionized wound care of chronic and complex wounds. This chapter reviews NPWT in various wound types, including diabetic foot ulcers, venous stasis ulcers, pressure injuries, and complex abdominal and thoracic wounds, as well as skin grafting. Advances in NPWT with instillation and dwell time (NPWTi-d) and closed incision NPWT (ci-NPWT) are explored, particularly in their role in infection control and prevention of surgical site infections, respectively. While growing clinical experience and observational data support its utility, this chapter also underscores the need for more randomized controlled trials to strengthen the evidence and guide best practices. This overview serves as a practical guide for optimizing NPWT in the surgical management of complex wounds.