Negative pressure therapy... 3 simple elements: a sponge/dressing that absorbs exudate, a port, and a device that generates negative pressure. Sometimes even 2, when the dressing is integrally connected to the port. It would seem that it is difficult to come up with too many options in such a simple scheme. Nothing could be further from the truth. Over the dozen or so years in which we have been using negative pressure as standard, there have been many breakthroughs. Open abdomen treatment, negative pressure prophylaxis, expansion of indications or gradual withdrawal from absolute contraindications, irrigation, endoscopic negative pressure therapy... these are just a few examples of how many therapeutic options can be obtained from this simple initial negative pressure “base.” Fortunately, the use of negative pressure itself is no longer something exceptional or reserved for special situations. Technical issues such as application and tightness are also no longer a challenge. However, strategy remains a challenge. The idea of when to use negative pressure, how to integrate it into the wound treatment concept, how to achieve the goal. Because every wound, every healing disorder, whether it is an ulcer, an open abdomen or a fistula, must be treated with a treatment plan, knowing where we are going. Of course, it needs to be modified more than once or twice, but without a plan it is difficult to make rational decisions. The art of healing is the art of decision-making. Implementing them is already a “technical” stage; first you need to have an idea and a plan. And that's what it's all about, decisions.