A 74-year-old man visited emergency department after cultivator rollover accident. Cultivator handle was directly impalement at left medial thigh area and perianal perineum was penetrated (Fig. 1). Abdominal computed tomography showed penetrating wound at left thigh to perineal area with left ischial fracture (Fig. 2). Foreign body was removed and femoral venorraphy was conducted. Two days later, pad removal and transverse colostomy was formed. After procedure periproctal wound discharge was continued. Under local anesthesia, irrigation and debridement of necrotic periproctal wound was performed. Wound discharge was diminished but pus like oozing was remained. Ten days later, we applied negative pressure wound therapy system by V.A.C therapy (KCI, San Antonio, TX, USA) (Fig. 3). We were set to operate in continuous mode at a pressure of 125 mmHg. Equipment was applied for seven days. After the application of the equipment, partial wound closure was performed. Sixty days after initial surgery, patient was discharged [1,2].