INTRODUCTION: Negative pressure wound therapy with instillation and dwell time (NPWTi-d) has been shown to be a viable option in abdominal wound healing protocols. To shed additional light on NPWTi-d, the present case study describes the treatment of a large postsurgical abdominal wound. CASE REPORT: A 50-year-old female with multiple comorbidities underwent complete colectomy, end ileostomy, and percutaneous endoscopic gastronomy tube placement and subsequently developed a 27 cm x 22 cm x 7 cm abdominal wound that was approximately 85% covered by a thick layer of necrotic fat. After multiple surgical debridements over a 4-week timeframe, with recurrent adipose necrosis and failed surgical closure, NPWTi-d was initiated using 50 mL normal saline with 10-minute dwell time followed by 3.5 hours of continuous negative pressure at -125 mm Hg. Perforated foam was used in the wound bed. The NPWT dressings were changed twice weekly, and a physical debriding pad was used during dressing changes as needed. The instillation fluid was changed to an antimicrobial when an infection developed. Over the course of 6 weeks of treatment with NPWTi-d, progressive improvement was noted in wound size and depth; the final wound measurement was 25 cm x 22 cm x 4.5 cm, and 25% of the wound bed was covered with a thinner layer of necrotic tissue. Unfortunately, the patient died due to her underlying illness. CONCLUSIONS: Despite the patient's overall failure to thrive, poor nutrition, and persistent high acuity, this wound improved dramatically with attention to the complexities of stoma care and the use of NPWTi-d.