Recent government documents (Department of Health (DH), 2009) have suggested that as a result of advances in tissue viability, more complex wound care can now be provided in the community setting and that therapies such as negative pressure wound therapy (NPWT) should be commonplace with tissue viability professionals appointed to direct service provision and ensure high standards (DH, 2009). This is a major step forward in current thinking, however, there are still gaps in our understanding of NPWT with regard to both the mechanism of action and which wound types will respond most favourably to the therapy. Managing complex patients in the community setting can be challenging, add to this scenario a device that has to remain attached for around 22 out of 24 hours a day and there is a major challenge. It yet remains to be ascertained if it is appropriate for all patients or if some definitive exclusion criteria should be agreed. This paper will seek to explore the mechanism of action, benefits, and barriers to adoption in community settings.